Clinic Study Of Endovascular Repair On Stanford Type B Aortic Dissection

Part1The management of stable stanford Type B Aortic Disseetion:endovascular repair or Optimal medical therapyObjective:To compare the value and the clinical application of thoracic endovascular repair(TEVAR) in addition to optimal medical therapy and optimal medical therapy alone of stable stanford type B aortic disseetion(AD).Methods:This study retrospectively assessed118cases treated in our hospital for type B aortic dissection between January2002and January2012, Among them57cases received endovascular repair in addition to optimal medical therapy(arterial pressure according to World Health organization guidelines<120/80mmHg) and61cases received optimal medical therapy alone.There were99men and19women with the average age of57.887±11.890years(33-80years), including60(50.8%)acute-onset cases,14(11.4%)sub-acute-onset cases and44(37.4%)chronic cases.All cases, according to the locations of Primary tear, were divided into Bc and Bs type, and according to the Positions of aortic dilatation(>4.0cm), were divided into B1、B2and B3type.In the TEVAR+OMT group, there were2(3.5%)Bc type cases,2(3.5%)B1s type cases,15(26.3%)B2S type cases, and31(54.4%)B3S type cases, and in OMT Group,there were0(0.0%) Bc type cases,17(27.9%)B1s type cases,2(6.6%)B2s type cases, and21(34.4%)B3s type cases. CTA were reexaminated at1month,3month,6months,1year and annually thereafter during follow up period.the morbidity and aorta-related mortality in30days and late and aortic remodeling(complete obliteration and thrombosis of thoracic false-lumen)were assessed, logrank test were plotted to compare survival between the two groups.Results:In TEVAR+OMT group,68stent-grafts were implanted, and two stents were used in one cases, The primary success was achieved in98.6%Patients and there were no intraoperative death.The30-day morbidity and mortality were7.0%and0.0%in the TEVAR+OMT group, and0.0%and0.0%in OMT group.106cases(95.6%)obtained follow-up with the mean duration of43.3±36.7(0.2-110.0) months. CTA were reexamined laterly in57cases,including of40in TEVAR+OMT group and17in OMT group,aortic remodeling occurred in90.0%of patients with TEVAR and11.7%of those who received meical treatment alone.the later morbidity and mortality were1.8%and5.3%in TEVAR+OMT group and3.3%and8.2%in OMT group.respectively, The cumulative survival rate were100.0%、97.1%、93.5%、78.0%at1、2、4、7years in TEVAR+OMT group and98.4%、96.4%、90.8%、72.7%at1、2、4、9years in OMT group.there were no signifcantly differences between two groups statistically(χ2=0.019, P=0.890).Conclusion:for treatment of stable standford B aortic dissection,compared with opimal medical therapy,TEVAR can signficantly reduce the incidence of false lumen explanation,but have complications relating to operation,failing to improved survival rate. Part2Short-midterm curative effect of Thoracic endovascul araortic repair for stanford Type B Aortic Dissections[Abstract]Objective:To evaluate the safety and effectiveness of thoracic endovaseular aortic repair(TEVAR)for the treatment of stanford type B aortic dissection(AD)Methods:From January2002to January2012there were70consecutive Stanford B type ADs underwent TEVAR.There were62men and8women with mean age54.640±12.426years(33-79years).There were13complicated cases including rupture and impending rupture(n=3), serious malperfusion of visceral organs(n=4) or extremities(n=5), acute penetrating aortic ulcer(n=1).32cases were in acute stage,11cases were in subacute stage,and27cases in chronic stage.all mobidity and mortality during different periods、change of The max false lumen diameters、 endoleaks、complete obliteration and thrombus of the false lumens in the levels of stents after operation and the cumulative survival rate at1、2、4、7years were recorded. Kaplan-Meier were plotted to compare survival between the acute and chronic groups.Results:A total of71Thoracic Stent-Grafts(61imported stents and10domestic stents) were implanted to seal the entry tears in dissections, and1Patient had2stents implanted.Primary technical success was achieved in98.6%of patients and there was no intraoperative death.30-days mortality was33.0%(4/13) in complicated cases and0.0%(0/57)in other ones.The mean Follow-up period was41.3±34.7months(0.2-110.0months).45.7%and42.9%of cases achieved the complete obliteration and thrombus respectively of cases of the false lumens in the levels of stents. The max false lumen diameters of post-operation diminished significantly than pre-operation in three groups after rejecting to the influence of the max false lumen of preoperation (F=5.041, P=0.012).Late morbidity and mortality were5.7% (4/70)and4.2%(3/70).The cumulative survival rate at1、2、4、7years were96.6%、92.2%、86.4%and72.0%.There were21endoleaks(2major endoleaks,19minor and moderate endoleaks)in the Procedures.68.3%minor and moderate endoleaks sealed and relieved spontaneously in follow-up Period. survival were signifcantly differences between the acute and chronic groups statistically(χ2=4.027, P=0.040).Conclusion:TEVAR is an effective treatment for typeB AD and in short and Middle term.To avoid operation during acute stage if allowed might be helpful for Patients.regular follow-up imaging is neeessary Part3Complications analysis after endovascular stent-grafting of Sanford type B thoracic aortic dessectionsObjective:To update our experience with endovascular stent-graft treatment for type B aortic dissections (AD)with complete data in our hospital, with special consideration for occurrence and management of complications.Methods:From January2002to January2012,70consecutive patients in our hospital underwent endovasculer repair for Type B aortic dissection, which included64typical type B aortic dissections,3penetrating aortic ulcers,3intramural haemorrhages. There were62male and8female with mean age54.640±12.426years(range33-79). All complica-tions occurring during perioperatio、30days after operation and follow up period were recorded.follow-up protocol featured CTA at1、6and12months after operation,and annually thereafter.Results:Primary technical success was achieved in98.6%of patients, conversion to standard open repair was never required.The30-day morbidity and mortality were 14.3%and5.7%respectively. The mean follow-up period was41.3±34.7months. Late morbidity and mortality were5.7%and4.2%. Serious complications included serious endoleak(n=l), cerbral infarction(n=1), access vascular complication (n=4), acute renal failure(n=2),and other complications(n=3). minor and moderate endoleak rate was27.1%,71.0%of which disappeared lately.Conclusion:the morbidity and mortality of endovascular stent-graft treatment for Type B aortic dissection was lower, and was a safe operation. Part4The learning curve in performing thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection.Objective:To explore the learning curve in performing thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection.Methods:From january2002to january2012,70patients undergoing type B aortic dessection performed by a same operational team were retrospectively analyzed. The patients were divided into groups A to E (n=14) based on the operational date.and the operation time, morbidity relating to operation, and postoperative in-hospital time were compared between5groups. the operational outcomes in diffirent phase were analyzed.Results:No statistical differences were found among the groups in age, gender,classification,merging with hypertension、Diabetes and Active smoking, Maximum diameter of False lumen, viscera artery perfused by the False lumen and other characteristics.the operation time of A、B、C、D、E was respectively3.286±0.611hr、2.871±0.373hr、1.796±0.617hr、1.736±0.342hr、1.518±0.390 hr.statistics demonstrate that No significant differences were found in the operation time between groups A and B(P>0.05) or among the other3groups (P>0.05), but the operation time in group A and B were significantly longer than that in the other3groups (P<0.001). There wasn’t significant difference for morbidity relating to operation in5groups(P>0.05), and so was the postoperational in-hospital time (P>0.05).the28patients in group A and B received the operation within a time period of6.1yrs(4.6cases per year),operations in group CD and E were done respectively in2.2yrs,1.2yrs,and0.8yrs.Conclusion:the learning curve of performing thoracic endovascular aortic repair (TEVAR) for type B aortic dissection is approximately28cases, the operator can learn the surgical skills after performing28thoracic endovascular aortic repair (TEVAR) for type B aortic dissection at the yearly frequency of4.6cases.