Endovascular Aortic Repair For Stanford B Aortic Dissection And Postoperative Situation Of Aortic Remodeling At Midterm Follow-up

Objective: To investigate the effect of thoracic endovascular aortic repair forStanford B aortic dissection and the postoperative situation of aortic remodeling.Method: Retrospective analysis in Jan.2008–Dec.2013, the First AffiliatedHospital of Dalian Medical University and Dalian Municipal Central Hospital treated77cases of acute and chronic Stanford B aortic dissection underwent thoracic endovascularaortic repair. Evaluate the perioperative clinical curative effect, including the incidenceof complications and mortality rate. And followed up for3to75months,47casesreceived follow-up. Evaluate the outcome of endoleak and the CTA postoperative (≥3months) follow-up of aortic remodeling.Results: All77cases of patients with Stanford B aortic dissection (40patientswith acute cases,37cases of chronic patients) were successfully completed thoracicaortic endovascular repair, including22cases of the first break from the left subclavianartery opening <15mm patients. Respectively to the left subclavian artery block (12cases). Branched stent technology (6cases);"Chimney" technology (2cases) and the"hybrid" technology (2cases). Postoperative evaluation: TEVAR therapy success ratewas97.4%(75/77), the clinical success rate was92.2%(71/77);Hospitalization time 10-44d, an average of20.51±10.23d; During the period of hospitalization endoleaksrate of7.8%(6/77), the complication rate of19.5%(15/77), after the30-day mortalityof5.2%(4/77). Acute mortality (10%) was significantly higher than in chronic phase(0%), with statistical significance (P <0.05).47cases of postoperative follow-up ofpatients get results (≥3months): In the presence of endoleaks after six patients,including two cases of endoleaks gradually disappear,the two cases of missing nosignificant changes, there is a growing trend within the drain two cases. The other threepatients developed new endoleaks. Postoperative (≥3months) underwent CTA reviewaorta and true and false lumen diameter changes. The overall trend of thoracic aortictrue lumen after stent coverage increases, the false lumen decreases. True and falselumen diameter before surgery, the difference was statistically significant (P<0.05).Compared with the preoperative aortic diameter before, the difference was notstatistically significant (P>0.05). Thoracic false lumen thrombosis rate of85.1%(40/47).For the patients who have multiple lacerations in the distal abdominal aorta and did notdeal with in surgery, compare the abdominal aortic diameter and true lumen diameterafter operation, there was no significant change (P>0.05), the false lumen diametercompared with the preoperative comparison has increased (P<0.05). Thrombosis of thefalse lumen abdominal segment was only21.4%(9/42). One patient before surgery whohas multiple lacerations, some are in the abdominal aorta, TEVAR postoperative falselumen out of the abdominal aortic aneurysm were increased, Placing multiple stentsvisceral artery occlusion break, after five months again review the CTA see sectionthrombosis of the false lumen and significantly reduced, no blood vessels rupture,results were satisfactory.Conclusion: Thoracic aortic endovascular repair (TEVAR) is a safe and effectivetreatment for Stanford B aortic dissection. Development of technology to makeproximal landing zone to get the extension, more complex aortic dissection patientsreceive treatment. The results also showed that TEVAR follow-up treatment caneffectively promote the remodeling of the lumen of aortic dissection. For multiplelacerations of dissection suggesting giving early treatment to improve the prognosis of the disease.