| Objective:To observe the safety and early and mid-term efficacy of Thoracic endovascular aortic repair(TEVAR)in the treatment of Stanford Type B aortic dissection(TBAD),compare the aortic related mortality,complication rate and survival rate of TBAD patients with different operative timing,and summarize the influence of different operative timing on the prognosis of TBAD patients.To observe the dynamic changes of aortic remodeling(AR)after TEVAR operation and to provide relevant data for the national great vascular disease database.Methods:The clinical and imaging data of 217 patients with TBAD who received TEVAR treatment in suining central hospital from June 2013 to June 2018 were retrospectively analyzed.Follow-up was performed at 3,6,and 12 months postoperatively,followed annually thereafter.Part I:General baseline data of patients were collected:admission number,name,gender,age,smoking history,drinking history,previous disease history(hypertension,coronary heart disease,diabetes,hyperlipidemia).Death occurred during the perioperative period and follow-up period,and complications occurred during the perioperative period and follow-up period:internal leakage,translocation of covered stents,distal new hairpin of covered stents,reverse tearing type A dissection,stroke,spinal cord ischemia,acute kidney injury,etc.Part Ⅱ:preoperative and postoperative imaging data were collected to observe the changes in true and false lumen diameter and total aortic diameter of thoracic and abdominal aorta,as well as the formation of pseudolumen thrombosis,and to summarize the dynamic situation and rules of AR.Results:Part Ⅰ:A total of 217 patients with TBAD were included in this study.According to the time from onset to TEVAR treatment,they were divided into the acute phase group(group A,time<14 days)and the non-acute phase group(group B,time≥14 days).Among them,141 patients in group A were aged 60.1±12.8.There were 76 patients in group B(age 63.5±11.4).There were 160 male patients and 57 female patients.The comparison of preoperative baseline data between the two groups showed that there was A statistically significant difference in smoking status between the two groups.Among them,50.4%of the patients in group A had A history of smoking,and 34.2%of the patients in group B had A history of smoking,χ2=5.207,P=0.022.There was no significant difference in preoperative baseline data between the two groups(P>0.05).The perioperative mortality rate was 2.8%(group A:2.8%vs.group B:2.6%),the aorto-related mortality rate was 2.8%(group A:2.8%vs.group B:2.6%),and the incidence of complications was 14.7%(group A:14.9%vs.group B:14.5%).The differences between the groups were not statistically significant(P>0.05).The mortality rate at follow-up was 7.6%(5.8%in group A vs.10.8%in group B),aorto-related mortality rate was 4.3%(3.6%in group A vs.5.4%in group B),and the complication rate was 8.1%(8.8%in group A vs.6.8%in group B),with no statistically significant difference between the groups(P>0.05).The estimated 1,3,5-year survival rates(kaplan-meier)of 217 patients were 0.952,0.934,0.834,respectively.The survival rate of the two groups was compared by Renyi test,and the difference was not statistically significant(Q=1.544,P=0.245).Part Ⅱ:Through inclusion criteria and exclusion criteria,106 patients with complete imaging follow-up data of more than 1 year after surgery were obtained.The mean age was 61.1± 12.4,including 80(75.5%)males,26(24.5%)females,53(50.0%)males,51(48.1%)females,91(85.8%)males with hypertension,43(40.6%)males with hyperlipidemia,17(16.0%)males with coronary heart disease,and 18(17.0%)females with diabetes.True lumen diameter:aortic isthmus plane,pulmonary artery bifurcation plane,diaphragm plane,celiac trunk plane and left renal artery opening plane increased statistically compared with those before surgery(P<0.05).False lumen diameter:the size of the isthmic plane of the aorta and the bifurcation plane of the pulmonary artery was significantly smaller than that before surgery(P<0.05).Total diameter:there was no statistically significant difference in the change of each plane compared with that before surgery(P>0.05).Preoperative,postoperative 3,6,12 months of total thrombus rate of the plane cavity:The bifocal plane of the pulmonary artery was 21.05%,73.68%,43.75%,42.11%,the diaphragmatic plane was 18.42%,42.11%,37.50%,36.84%,the celiac trunk plane was 13.16%,5.26%,12.50%,10.53%,the left renal artery opening plane was 12.96%,4.86%,0.00%,5.22%,respectively.The abdominal aorta bifurcation planes were 0.00%,10.51%,6.25%and 9.89%,respectively.Conclusions:(1)The incidence of complications and mortality after TEVAR surgery are low,and the early and middle term curative effects are good.(2)There was no difference in the incidence of postoperative complications,aorto-related mortality and survival rate between the acute stage and the non-acute stage of TBAD,suggesting that the operation in the acute stage of TBAD would not bring higher risk of complications and death.TEVAR treatment could be performed in time for TBAD patients with surgical indications in the acute stage.(3)After TEVAR surgery,the true cavity diameter increased,the false cavity diameter decreased,and the false cavity thrombosis was formed and absorbed mechanically.The thoracic aortic segment AR was superior to the abdominal aortic segment.(4)No significant change in the false lumen diameter and total diameter of the distal pseudocavity after TEVAR surgery may indicate that the interlayer is stable,and the distal rupture does not require surgical treatment for the time being,but requires close follow-up.(5)TEVAR technology is minimally invasive,simple and efficient,and can be routinely carried out in primary hospitals.(6)The data in this study are true and reliable,which provides a reference for the center to carry out TEVAR technology in the future. |
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