Concluding Of Management To Aortic Dissection (Stanford Type-B) And Midterm Results Of Those Treated By Endovascular Repair With Stent-grafts

PURPOSE:To conclude the experience in dealing with type-B aortic dissection and report the midterm results of the endovascular treatment of type-B aortic dissection with use of stent-grafts.MATERIALS AND METHODS:Of all patients(n=364) with acute or chronic type-B aortic dissection treated in our center,with those death(n=21),those with custom-made stent-grafts(n=251),.those with type-A aortic dissection(n=9)after endovascular treatment and by analysis of case history,imaging materials,therapeutics records and follow-up outcomes,to conclude clinical features of patho-physiological change(anatomical change,haemodynamics turnover,frequency of branch arteries involvement),to identify risk factors and interventions on tending to death,to find routine in those with type-A aortic dissection after endovascular treatment,to follow-up outcomes and complications of those with custom-made stent-grafts.RESULTS-Chest-back pain(73.1%,266/364) and hypertension(86.8%,316/364) are most frequent symptons and for aortic dissection(Stanford Type-B),respectively.8% (361/1456) of visceral arteries emerge form false luman,other 5.6%(82/1456) emerge form both false and true luman.pleural effussion(P＜0.001),large aneurysm (P＜0.001),pain diseasement(P＜0.001),uncontrolled hypertension(P=0.005) are risk factors for rupture.Weak-induced factors for intima,such as Mafan symdrome and intima impairment,was apt to generate aortic dissection(Stanford type-A).11 cases (4.4%)underwent bypass before operation and 1.61%(4/251)received visceral arteries bypass.Left subclavian artery was coverd simultaneously without bypass in 34 cases.There are 6.4%(14/25) developed type-Ⅰendoleak,94.0%(236/251)experienced technical success.There are also embolic stroke(3/251),weakened pulsation of upper extremity artery(10/251) without paraplegina。After two weeks～five year's follow-up,there were 7.8%(5/64) developed type-Ⅰendoleak and 4 of them required a secondary grant-shift;3.1%(2/64) received stent shift;3.1%(2/64)developed aortic dissection(Stanford type-A) and was treated with operation named Bentall,1 case of them experienced type-Ⅰendoleak and received endovascular repair.The incidence of type-Ⅰendoleak is correlation to maximum diameter of aorta before operation (P=0.001) and diference between pre-operation and post-operation(P=0.026),initial endoleak(P＜0.001).Initial endoleak(P=0.019)was the only independable risk factor for occurrence of type-Ⅰendoleak after multivariable logistical quantitative analysis. Proximal false luman was expected to disappear(21/64,32.8%) and thrombosis (33/64,51.6%) while remote false luman was with a tendency to be streamflowing (39/64,60.9%).CONCLUSIONS:The aged people were frequently effected.Most of them broke out in winter and spring.Branch arteries of aorta were usually involved and related symptoms commonly disappeared after endovascular treatment.Some indicators can suggest early rupture.There were less complications with endovascular repair,including endoleak and embolic stroke and rare death.Episode of endoleak in follow-up was in correlation to initial endoleak,big aneurysm and so on.Multiple regression analysis confirmed initial endoleak was the only independent risk factor.Opration with patienceis and keep intima integrity was the key to relieve patients from Type-A aortic dissection.Patients with Mafan syndrome should be cautious with endovascular treatment.Initial efficacy and safety can be observed in patients treated with LSA covered.Endovascular treatment of type-B aortic dissection is technically feasible and effective.Thrombosis can be observed in proximal false lumen,however,it was a dynamic process;Remote false lumen permited persistent bloodstream existencewithout early aneurysm formation.If no necessary,positive actions were not required for remote false lumen.Closely monitoring the treated aorta is essential to detect early aneurysm formation and a distant intimal tear at the ends of rigid stents.