Prognostic factors for aorta remodeling after thoracic endovascular aortic repair of complicated chronic DeBakey IIIb aneurysms

被引:33
作者
Song, Suk-Won [1 ]
Kim, Tae Hoon [1 ]
Lim, Sun-Hee [1 ]
Lee, Kwang-Hun [2 ]
Yoo, Kyung-Jong [3 ]
Cho, Bum-Koo [4 ]
机构
[1] Yonsei Univ, Coll Med, Gangnam Severance Hosp, Dept Thorac & Cardiovasc Surg, Seoul 135720, South Korea
[2] Yonsei Univ, Coll Med, Gangnam Severance Hosp, Dept Intervent Radiol, Seoul 135720, South Korea
[3] Yonsei Univ, Coll Med, Severance Hosp, Dept Cardiovasc Surg,Yonsei Cardiovasc Hosp, Seoul 135720, South Korea
[4] Korea Heart Fdn, Seoul, South Korea
关键词
STENT-GRAFT; DISSECTION; OUTCOMES; DEVICE; TEARS;
D O I
10.1016/j.jtcvs.2014.05.040
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: The use of thoracic endovascular aortic repair (TEVAR) for chronic DeBakey III type b (CDIIIb) aneurysms is controversial. We analyzed the potential prognostic factors affecting aorta remodeling after this procedure. Methods: A total of 20 patients with CDIIIb aneurysms underwent TEVAR, with full coverage of reentry tears at the descending thoracic aorta. The potential factors affecting false lumen (FL) remodeling were analyzed, including reentry tears (communicating channels visible on the computed tomography angiogram), large intimal tears below the stent graft (>= 2 consecutive axial cuts on the computed tomography angiogram), visceral branches arising from the FL, and intercostal arteries (ICAs) arising from the FL. Results: All the patients had uneventful in-hospital courses; 2 patients (10%) required reintervention during the follow-up period. Thirteen patients (65%) had complete thrombosis of the FL at stent graft segment. Compared with the complete thrombosis group, the partial thrombosis group had more reentry tears (1.8 vs 2.3, P = .48), large intimal tears (0.8 vs 1.7, P < .05), visceral branches arising from the FL (1.2 vs 2.3, P < .05), and ICAs arising from the FL (3.8 vs 5.1, P = .35). Reentry tears, visceral branches, and ICAs from the FL were significant negative prognostic factors for FL shrinkage (P < .05). Conclusions: Although reentry tears above the celiac trunk were fully covered, the visceral branches and ICAs from the FL and all communicating channels below the celiac trunk kept the FL pressurized and were unfavorable prognostic factors for aorta remodeling after TEVAR for CDIIIb aneurysms.
引用
收藏
页码:925 / 932
页数:8
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