Clinical Study On The Outcome Of Distal Tear After Intracavitary Repair Of Stanford Type B Aortic Dissection

Objective:To investigate the effect of the initial curative effect and the outcome of distal tear after EVAR of Stanford type B aortic dissection on the recovery of patients.Methods:Retrospective analysis was performed on 47 patients,suffering from TBAD,were admitted to our hospital during Jan.2014 to Nov.2019.CTA examination of all patients indicated standard B type aortic dissection.All patients received endovascular repair during hospitalization.According to the number of postoperative distal lacerations,they were divided into single distal tear(group A)and multiple distal tear(group B),acute stage(group C)and non-acute stage(group D)according to the different treatment stages of the dissection at the time of operation,and the non-acute stage group included subacute stage and chronic stage.Follow-up was conducted at 3,6 and 9 months after surgery,mainly including CTA imaging results,biochemical indexes,postoperative discomfort symptoms,and second-stage intervention.The postoperative symptoms,the remodeling of the aorta and the outcome of the distal rupture were compared.Result:All surgeries are successfully,and no patients died during Hospitalization.During the postoperative follow-up,the true lumen in the area covered by the aortic stent was significantly enlarged,while the false lumen was significantly reduced,and the aortic remodeling was good.The aortic remodeling in areas without stent coverage was poor.But group A has more advantages than group B.In the stent covered segment,group A had better recovery than group B.Compared with group A,group B was more prone to postoperative leakage.Group C was more prone to internal leakage than group D.There were 4 patients with renal insufficiency before surgery,and the biochemical indexes of renal function improved significantly after surgery.Eighteen patients complained of chest and back pain during postope-rative hospitalization.Postoperative chest and back pain was not significantly improved or even worsened in 2cases.Postoperative abdominal pain symptoms were significantly improved in 7cases.Preoperative lower extremity numbness in 1 case recovered after surgery.Patients with preoperative syncope improved postope-ratively.The decrease of upper limb muscle strength and recovery of lumbar cistern drainage were observed in.2 cases.There was no statistical difference in postoperative discomfort symptoms between group A and group B,and no statistical significance in postoperative discomfort symptoms between group C and group D.After operation,4 cases underwent surgical treatment due to severe distal rupture.Type I leakage occurred in one case during the follow-up,and secondary operation was performed.Conclusions:The aorta remodeling of stent covered segment was better after endovascular repair.Aortic remodeling after endoluminal repair is related to the number of distal rupture,and the remodeling after distal single rupture is better.The occurrence of postoperative leakage is related to the number of distal rupture and the disposal period of the dissection during operation.The distal rupture was closed in the first stage,and if serious effects were found during the follow-up,it could be closed in the second stage.The sequence of closure was from near to far.