Treatment Of Distal Tear Of Stanford Type B Aortic Dissection

Objective:To explore the occurrence characteristics and treatment strategies of the distal tear of type B aortic dissection,and provide reference for clinician to give more reasonable treatment plan for the patients.Methods:The clinical data of patients diagnosed with TBAD at the Department of Vascular Surgery of China-Japan Union Hospital of Jilin University from September 2013 to September 2016 were collected.According to the time of onset,the disease course was divided into 3 phases: acute phase(within 2 weeks),subacute phase(2 weeks to 2 months)and chronic phase(more than 2 months).According to the location of the distal tear and treatment strategy,the distal tear of dissection is divided into 3 types: Type I is located above the opening of the celiac trunk artery,type II is located between the opening of the celiac trunk artery and the opening of the lower renal artery,and type III is located below the opening of the lower renal artery.The preoperative imaging characteristics and treatment options and postoperative follow-up conditions were statistically analyzed.At the same time,the occurrence characteristics and treatment strategies of the distal tear of TBAD were systematically analyzed and discussed in combination with domestic and foreign literature reports.Results:A total of 45 patients with TBAD diagnosed in our department were collected,including 31 males and 14 females,with an average age of 59.3±3.4 years,ranging from 43 to 72 years old.Of all the patients,28 cases were in acute stage,12 cases were in subacute stage and 5 cases were in chronic stage.There were 42 cases(93.3%)with distal tears,with a total of 97 tears(2.3/person),the amount of type I were 10(10.5%),type II were 64(65.8%)and type III were 23(23.7%).Among them,33 cases were treated with TEVAR operation in hospital and followed up effectively.All of the 33 cases were treated with TEVAR operation to close the proximal tears in the first stage,and the technical success rate was 100%.At the request of the patient and his families,one patient in subacute phase underwent distal tear closure in first stage.All of the other patients were followed up by CTA or telephone calls according to the actual situation at 1 month,3 months,6 months,and every 1 year after surgery.There were tumor-like dilatation at the distal end of the dissection in 2 patients in chronic phase,and they were underwent distal dissecting closure in the second stage.In 1 case in acute and 1 case in subacute phase,intraoperative angiography showed large reflux of the distal tears.During the reexamination,it was found that the false lumen in the subrenal abdominal aorta was obviously dilated.One patient underwent hybrid surgery.One patient refused treatment and was subsequently lost to follow-up.The follow-up of the other patients did not have obviously abnormality that require secondary surgical intervention.False lumens were thrombotic and narrowed in patients who were treated with distal tears,and the speed and extent were better than those of the untreated patients with distal tears.Conclusion:1.TEVAR operation is an effective method for the treatment of type B aortic dissection.However,the treatment of distal tear of dissection is complex,so we should stick to the principle of individualization and analyze the concrete situation.2.Regular and planned follow-up is very important,early detection and early treatment reduce the risk of disease and improve treatment efficacy.CTA or MRA examination is preferred for follow-up.