Analysis Of Early And Mid-term Clinical Treatment Effect Of Type B Penetrating Atherosclerotic Aortic Ulcer

Objective: To investigate the clinical effect of thoracic endovascular aortic repair(TEVAR)in the treatment of type B aortic penetrating ulcer(PAU).Compare the clinical efficacy andnear-intermediate results of TEVAR surgery and conservative treatment.Methods: The clinical data and follow-up results of patients with type B aortic penetratingulcer who underwent thoracic endovascular aortic repair or conservative treatment in theDepartment of Cardiovascular Surgery,Qingdao University Hospital from July 2014 toFebruary 2018 were retrospectively analyzed.Of the 110 patients followed up,90(82%)were male and 20(18%)were female,aged 36-80(67.7 ± 9.6)years.98 patients(89%)wereadmitted to hospital with acute chest pain and were eligible for acute aortic syndrome(AAS).12 patients(11%)found type B aortic penetrating ulcers due to a physical examination.All110 patients were diagnosed by aortic CT angiography(CTA).Of these,80 patientsunderwent thoracic endovascular aortic repair and 30 patients underwent conservativetreatment.All patients were followed up for 8-24(12.4±3.6)months.Results: All the 80 patients(72.7%)who underwent surgery were successfully operated.Among them,8 patients underwent emergency surgery because of severe symptoms.Theother 72 patients were given absolute bed rest and blood pressure control before operation tosurvive the acute phase.The waiting time before surgery was 10-16(12.6±2.6)days,and thepostoperative hospital stay was 4-19(8.5±4.1)days.2 cases of them(2.5%)had cerebralinfarction after operation.There were no deaths during the follow-up period.6 patients(7.5%,6/80)were found to have recurrent penetrating ulcer at the distal end of the stentduring the follow-up period.8(10%,8/80)cases of postoperative CTA found endoleak,2case of a small amount of type I endoleak,6 cases of a small amount of type II endoleak.After a few months,the patient reviewed CTA and found that the endoleak disappeared.Thestent grafts of other patients were in right stent adherence.No displacement or fracture werefound.The lesions were completely closed.Symptoms disappear completely.The effects ofoperations were satisfying.Five of the 80 surgical patients had no pain symptoms.In 3months after surgery,63 patients(84%,63/75)had complete disappearance of painsymptoms;the final 70 patients(93.3%,70/75)had complete disappearance of painsymptoms.30(27.3%)patients who received conservative treatment were given absolutebed rest,antihypertensive,sedative and analgesic treatment after admission.The hospitalstay was 10-18(13.2±2.5)days.During the follow-up period.6 patients(20%,6/30)underwent surgery because of relapse.Seven of the 30 conservatively treated patients had nopain symptoms.Three months after discharge,9(39.1%,9/23)pain symptoms completelydisappeared;the final 17(73.9%,17/23)pain symptoms completely disappeared.Conclusion: thoracic endovascular aortic repair is a safe and effective treatment for type Bpenetrating atherosclerotic aortic ulcer.Conservative treatment is effective.But the early andmid-term results of conservative treatment were not as good as endovascular repair.Thelong-term effect of these two methods still lack evidence-based medical evidence,whichneeds further study.Significance:There is still no clear definition of the complexity of type B aorticpenetrating ulcers.Therefore,there were some controversy in the choice of treatmentmethods.Each center decided the treatment plan according to its own experience and patientsituation,but most reports recommended surgical treatment.There is still a lack of summaryand coverage of conservative treatment.In this study,I summarized the clinical outcomes ofaortic penetrating ulcers,and explored the effects of endovascular repair and non-surgicaltreatment in the near-term,and provided more evidence for the treatment of aorticpenetrating ulcers.