Effects of Distal Tears on Aortic Remodeling after TEVAR for Stanford Type B Aortic Dissection in Subacute Period_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Jiang ,  HU Hejie , WANG Xiaotian , FANG Zhengdong , SUN Xiaojie , GE Xinbao , CHENG Can , RAO Congliang , SHEN Tianjiao

Corresponding author：

HU Hejie, Email: hu.hejie@163.com

Keywords：

Stanford type B aortic dissection; TEVAR; distal break; remodeling

DOI：

10.7507/1007-4848.201712010

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ObjectiveTo investigate the effect of distal tears on postoperative aortic remodeling after Thoracic Endovascular Aortic Repair (TEVAR) for the patients with subacute stage of Stanford type B aortic dissection.MethodsForty three cases with Stanford type B aortic dissection, admitted in Anhui Provincial Hospital from July 2011 to April 2015, who underwent TEVAR to repair the proximal aortic entrance tear, after which the blood reflex from distal tears were still observed were analyzed retrospectively. According to the number of heart volume required to fill the two groups, group A (≤2 heart rate) group B （>2 heart rate）, We then assessed the changes of the true and false lumen area and analyzed the effects of direction of blood flow and the number of heart rate to fill the false lumen on formation of false lumen thrombosis in the period of 3–24 months.ResultsAll the stents were successful implanted. There was a statistically significant difference in lumen area between the two groups before and after surgery, and univariate analysis showed that the direction of distal rupture of blood flow into the false lumen had no effect on postoperative aortic remodeling (P<0.05), but postoperative hypertension (≥140/90 mmHg) slows down the formation of false lumen thrombosis.ConclusionPatients had entrance tear in the distal of aortic, still broken and faster flow after TEVAR stent-graft implantation in the proximal closed entrance tear. Blood pressure should be strictly controlled and close follow-up also needed, meanwhile, the distal entrances can be closed the same period if there is a faster flow from them.

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6.	Melissano G, Bertoglio L, Rinaldi E, et al. Volume changes in aortic true and false lumen after the "PETTICOAT" procedure for type B aortic dissection. J Vasc Surg, 2012, 55(3): 641-651.
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1. Akgul A, Gursoy M, Bakuy V, et al. Spontaneous triple coronary artery dissection. Ann Thorac Surg, 2013, 95(4): 1443-1445.
2. 任昊, 慈红波, 方青波, 等. 探讨 Stanford B 型主动脉夹层远端破口的分布特点及临床分型. 国际外科学杂志, 2014, 41(12): 824-826, 封3.
3. 张震, 杨绍军, 王家平. Stanford B 型主动脉夹层腔内隔绝术后主动脉重塑的特点及影响因素. 中国现代普通外科进展, 2009, (11): 957-960+978.
4. Nauta FJ, Trimarchi S, Kamman AV, et al. Update in the management of type B aortic dissection. Vasc Med, 2016, 21(3): 251-263.
5. Lombardi JV, Cambria RP, Nienaber CA, et al.Aortic remodeling after endovascular treatment ofcomplicated type B aortic dissection with the useof a composite device design. J Vasc Surg 2014;59(6):1544–54.
6. Melissano G, Bertoglio L, Rinaldi E, et al. Volume changes in aortic true and false lumen after the "PETTICOAT" procedure for type B aortic dissection. J Vasc Surg, 2012, 55(3): 641-651.
7. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283(7): 897-903.
8. 中华医学会外科学分会血管外科学组. 主动脉夹层腔内治疗指南.
9. Han SM, Kuo EC, Woo K, et al. Remodeling of abdominal aortic branch perfusion after thoracic endovascular aortic repair for aortic dissections. J Vasc Surg, 2016, 64(4): 902-911.
10. Alfson DB, Ham SW. Type B Aortic Dissections: Current Guidelines for Treatment. Cardiol Clin, 2017, 35(3): 387-410.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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