Mustafa PARILDAR, Çınar CELAL, Halil BOZKAYA, Hakan POSACIOĞLU, Serkan ERTUGAY

Does endovascular repair affect aortic remodeling in acute complicated type B aortic dissection?

Amaç: Bu çalışmada, akut komplike tip B aort diseksiyonunedeniyle torasik endovasküler aort tamiri (TEVAR) uygulananhastalarda, uzun dönemdeki gerçek ve yalancı lümenlerinhacim değişiklikleri araştırıldı. Çalışmaplanı:Mart 2003 - Kasım 2012 tarihleri arasındakliniğimizde akut komplike tip B aort diseksiyonu nedeniyleTEVAR uygulanan 18 ardışık hasta (14 erkek, 4 kadın; ort.yaş 61.9±11 yıl; dağılım 39-77 yıl) çalışmaya dahil edildi. Sonvizitte elde edilen bilgisayarlı tomografi taramaları, gerçekve yalancı lümen hacimlerini ölçmek için kullanıldı. Ortancatakip süresi 35.3 (dağılım 12-84) ay idi. Girişim endikasyonu17 hastada rüptür veya malperfüzyon (bazı hastalarda her ikisibirlikte), bir hastada ise inatçı göğüs ağrısı idi. İnen torasikaortun (DTA) stentli kısmı Segment 1, DTAnın stentsiz olankısmı (supraçölyak) Segment 2 ve abdominal aort Segment 3olarak tanımlandı. Bul gu lar: Segment 1de ortalama gerçek lümen hacmi74.4±49 mLden 110±50 mLye yükselirken (p=0.0145),ortalama yalancı lümen hacmi 124.2±81 mLden 59.5±59 mLyedüştü (p

Akut komplike tip B aort diseksiyonunun endovasküler tamiri aortun yeniden biçimlenmesini etkiler mi?

Background: This study aims to analyze the volume changesof true and false lumens at a late stage in patients undergoingthoracic endovascular aortic repair (TEVAR) due to acutecomplicated type B aortic dissection. Methods: Between March 2006 and November 2012, 18consecutive patients (14 males, 4 females; mean age was 61.9±11years; range 39 to 77 years) who underwent TEVAR for acutecomplicated type B aortic dissection in our clinic were included inthis study. Computed tomography scans obtained at the final visitwere used for the volume analysis of true and false lumens. Themedian follow-up was 35.3 (range, 12 to 84) months. Indicationsfor intervention were rupture or malperfusion in 17 patients(both in some patients) and persistent chest pain in one patient.The stent-graft part of the descending thoracic aorta (DTA) wasdefined as Segment 1, DTA without stent-graft (supraceliac) asSegment 2, and the abdominal aorta as Segment 3. Results: In segment 1, the mean volume of true lumen increasedfrom 74.4±49 mL to 110±50 mL (p=0.0145), while the meanvolume of false lumen decreased from 124.2±81 mL to 59.5±59mL (p

PDF

___

1. Estrera AL, Miller CC, Safi HJ, Goodrick JS, Keyhani A, Porat EE, et al. Outcomes of medical management of acute type B aortic dissection. Circulation 2006;114:384-9.
2. Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol 2013;61:1661-78.
3. Duson SM, Crawford RS. The role of endografts in the management of type B aortic dissections. Perspect Vasc Surg Endovasc Ther 2012;24:177-83.
4. Conrad MF, Crawford RS, Kwolek CJ, Brewster DC, Brady TJ, Cambria RP. Aortic remodeling after endovascular repair of acute complicated type B aortic dissection. J Vasc Surg 2009;50:510-7.
5. Rodriguez-Lopez JA, Diethrich EB. Diameter or volume? The measure of success after endovascular repair of thoracic aortic dissections. J Endovasc Ther 2009;16:39-41.
6. Song TK, Donayre CE, Walot I, Kopchok GE, Litwinski RA, Lippmann M, et al. Endograft exclusion of acute and chronic descending thoracic aortic dissections. J Vasc Surg 2006;43:247-58.
7. Rodriguez JA, Olsen DM, Lucas L, Wheatley G, Ramaiah V, Diethrich EB. Aortic remodeling after endografting of thoracoabdominal aortic dissection. J Vasc Surg 2008;47:1188-94.
8. Schoder M, Czerny M, Cejna M, Rand T, Stadler A, Sodeck GH, et al. Endovascular repair of acute type B aortic dissection: long-term follow-up of true and false lumen diameter changes. Ann Thorac Surg 2007;83:1059-66.
9. Kim KM, Donayre CE, Reynolds TS, Kopchok GE, Walot I, Chauvapun JP, et al. Aortic remodeling, volumetric analysis, and clinical outcomes of endoluminal exclusion of acute complicated type B thoracic aortic dissections. J Vasc Surg 2011;54:316-24.
10. Andacheh ID, Donayre C, Othman F, Walot I, Kopchok G, White R. Patient outcomes and thoracic aortic volume and morphologic changes following thoracic endovascular aortic repair in patients with complicated chronic type B aortic dissection. J Vasc Surg 2012;56:644-50.
11. Walker PJ, Dake MD, Mitchell RS, Miller DC. The use of endovascular techniques for the treatment of complications of aortic dissection. J Vasc Surg 1993;18:1042-51.
12. Nienaber CA, Rousseau H, Eggebrecht H, Kische S, Fattori R, Rehders TC, et al. Randomized comparison of strategies for type B aortic dissection: the INvestigation of STEnt Grafts in Aortic Dissection (INSTEAD) trial. Circulation 2009;120:2519-28.
13. Brunkwall J, Lammer J, Verhoeven E, Taylor P. ADSORB: a study on the efficacy of endovascular grafting in uncomplicated acute dissection of the descending aorta. Eur J Vasc Endovasc Surg 2012;44:31-6.
14. Marui A, Mochizuki T, Mitsui N, Koyama T, Kimura F, Horibe M. Toward the best treatment for uncomplicated patients with type B acute aortic dissection: A consideration for sound surgical indication. Circulation 1999;100:275-80.
15. Huptas S, Mehta RH, Kühl H, Tsagakis K, Reinsch N, Kahlert P, et al. Aortic remodeling in type B aortic dissection: effects of endovascular stent-graft repair and medical treatment on true and false lumen volumes. J Endovasc Ther 2009;16:28-38.
16. Tsai TT, Evangelista A, Nienaber CA, Myrmel T, Meinhardt G, Cooper JV, et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med 2007;357:349-59.
17. Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part II: therapeutic management and follow-up. Circulation 2003;108:772-8.