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Objective:To compare the curative effect and cost of domestic and imported covered stents in the treatment of non-complex Stanford type B aortic dissection.Methods:A retrospective case-control study was used to analyze the clinical data of 93 patients with non-complex Stanford B aortic dissection who underwent thoracic endovascular aortic repair (TEVAR) in Taizhou Second People's Hospital from September 2016 to September 2021.Ninty-three patients were divided into two groups according to the use of different covered stents during the operation, of which 47 patients were treated with domestic covered stents (observation group) and 46 patients were treated with imported covered stents (control group). Overall response rate, rate of complication, treatment cost and cost-effectiveness ratio of the two groups were compared and sensitivity analysis was performed in the two groups.The measurement datas conforming to the normal distribution were expressed as mean ± standard deviation( ± s), and the inter-group comparison was conducted by t test.The comparison of counting datas between groups was conducted by Chi-square test or Fisher exact probability method. Results:The overall response rate of the observation group and the control group were 93.62% and 97.83%, with no significant difference ( P>0.05); The incidence of complications was 6.38% and 2.17%, with no significant difference ( P>0.05). The cost of covered stent [(62 155.49±10 231.08) yuan] and the total cost of treatment [(95 063.66±20 042.34) yuan] in the observation group were lower than those in the control group [(93 825.37±16 577.04) yuan and (126 035.89±26 186.18) yuan]( P<0.05). There was no significant difference in other direct costs between the observation group [(32 908.17±9 811.26) yuan] and the control group [(32 210.52±9 609.14) yuan] ( P >0.05). The cost-effectiveness ratio of the observation group and the control group were 1 015.42 and 1 288.31, and the incremental cost-effectiveness ratio of the control group was 7 356.82. After the cost-effectiveness sensitivity analysis and adjusting the cost of the covered stent to decrease by 10% of the two groups, the cost-effectiveness ratio of the observation group and the control group were 949.03 and 1 192.41, and the incremental cost-effectiveness ratio of control group was 6 604.61. Conclusions:Both domestic and imported covered stents are effective in the treatment of non-complex Stanford type B aortic dissection with fewer complications. Compared with the imported covered stent, the domestic covered stent has lower treatment cost and more advantages of cost-effectiveness, which is more in line with diagnosis related groups reform.
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Objective Based on hemodynamic analysis, to investigate the cause of distal re-entry tear in Stanford type B aortic dissection after thoracic endovascular aortic repair (TEVAR).Methods A patient with type B aortic dissection was reexamined regularly with computed tomography angiography (CTA) at 1st month, 6th month, 12th month and 24th month after TEVAR. Based on the CTA images in each period, three-dimensional (3D) aorta models were reconstructed to perform morphological analysis and hemodynamic simulation.Results Compared with the diameter at 1st month after TEVAR, the diameter of true lumen at 12 months after TEVAR increased by 1.8 times and the global distortion of aorta increased by 16.67%. At postoperative 1st, 6th and 12th month, the maximum blood velocities at the new entry tear in systole were 69.6%, 33.7% and 92.1% higher than the average ones at distal landing zone, and the maximum wall shear stresses (WSSs) were 2.52, 2.32 and 3.52 times of the average WSSs respectively. In addition, the maximum time-averaged WSS (TAWSS) at 1st, 6th and 12th month after TEVAR were 1.88, 2.53 and 3.62 times of the mean TAWSS respectively.ConclusionsThe morphology of the aorta remodeled after TEVAR, and a sudden change in the diameter of true lumen occurred at distal anchoring zone and continued to increase. As a result, the blood flow velocity in this area accelerated, and the intima was continuously exposed to high WSS, leading to the redissection.
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Objective:To investigate the clinical characteristics as well as short-term and long-term prognostic factors of patients with Stanford type B aortic dissection (TBAD) with hypertension.Methods:Patients with TBAD who received thoracic endovascular aortic repair (TEVAR) admitted to Xiangyang Central Hospital from January 2014 to December 2018 were enrolled. The baseline data of patients admitted to the hospital were collected through the case management system, including gender, age, underlying diseases (hypertension, diabetes, coronary heart disease), smoking history, drinking history, duration of pain, vital signs at admission [heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP)], laboratory results [white blood cell count (WBC), platelet count (PLT), neutrophil/lymphocyte ratio (NLR), serum creatinine (SCr), C-reactive protein (CRP), D-dimer, ascending aorta diameter], etc. The clinical characteristics of TBAD patients with hypertension were analyzed. Logistic regression model and Cox proportional risk model were used to analyze the impact of hypertension on the short-term and long-term all-cause deaths after TEVAR in TBAD patients.Results:Among 227 TBAD patients, 160 cases (70.5%) were complicated with hypertension, while 67 cases (29.5%) were not. The average age, the proportion of diabetes and coronary heart disease, and the level of SBP, DBP and SCr at admission of TBAD patients with hypertension were higher than those of TBAD without hypertension [age (years old): 53.1±11.9 vs. 42.8±14.1, combined with diabetes: 8.8% vs. 1.5%, combined with coronary heart disease: 6.3% vs. 0%, SBP (mmHg, 1 mmHg = 0.133 kPa): 147.9±18.1 vs. 136.9±15.2, DBP (mmHg): 93.9±11.9 vs. 89.1±13.8, SCr (μmol/L): 97.8±25.4 vs. 89.8±23.6, all P < 0.05]. The short-term mortality of TBAD with hypertension group was significantly higher than that of TBAD without hypertension group [6.3% (10/160) vs. 0% (0/67), χ2 = 4.386, P = 0.036]. 227 patients with TBAD were followed up for 3-66 months, with a median follow-up time of 25 months. There was no significant difference in long-term mortality between TBAD patients with and without hypertensive during discharge follow-up [13.1% (21/160) vs. 9.0% (6/67), χ2 = 0.784, P = 0.376]. Further multivariate Logistic regression analysis and Cox regression analysis did not indicate that hypertension was an independent risk factor for short-term and long-term death in TBAD patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 13.477 (0.541-330.215), 1.012 (0.990-1.035), both P > 0.05]. Age and HR were independent risk factors for the short-term mortality of TBAD patients [ OR and 95% CI were 15.287 (1.051-226.415), 0.026 (0.002-0.840), both P < 0.05]. Age, PLT and D-dimer were independent risk factors for the long-term mortality of TBAD patients [ OR and 95% CI were 1.808 (1.205-2.711), 0.555 (0.333-0.924), 1.482 (1.035-2.122), respectively, all P < 0.05]. Conclusions:The TBAD patients with hypertension have older age, high rates of diabetes or coronary heart disease. However, hypertension is not an independent risk factor for short-term and long-term mortality in TBAD patients.
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<p>Case : A 75-year-old man was brought to our hospital by ambulance with dorsal pain. Contrast-enhanced computed tomography (CT) revealed acute communicating aortic dissection (Stanford type B) complicated by an aberrant right subclavian artery (ARSCA). Under a diagnosis of type B dissection, conservative treatment by hypotensive therapy and resting was performed. One month after onset, contrast-enhanced CT showed the expansion of the false lumen, and intermittent abdominal pain persisted. To close the entry of the distal arch and reconstruct the ARSCA route, right common carotid artery-right axillary artery bypass, thoracic endovascular aortic repair (TEVAR), and coil embolization of the ARSCA were performed. Five days after surgery, contrast-enhanced CT revealed the expansion of a false abdominal lumen. Abdominal endovascular aortic repair (EVAR) was additionally conducted, leading to the disappearance of false lumen blood flow. ARSCA is a congenital arch vessel abnormality. It may cause obstruction of the esophagus/trachea, aortic aneurysm/dissection of an adjacent area, or aneurysmal changes/rupture of the ARSCA. Various techniques have been reported ; reconstruction of the ARSCA route and closure of the false lumen by de-branch TEVAR may be effective for acute communicating aortic dissection with an ARSCA.</p>
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Objective To explore the optimal treatment options of Stanford type B aortic dissection. Methods A to?tal of 51 patients with Stanford type B aortic dissection who visited the General Hospital of Tianjin Medical University from May 2008 to March 2013 were analyzed retrospectively. Survival and recovery of patients were evaluated by follow ups. Pa?tients were divided to TEVAR group(40 cases)and conservative group(11 cases)according to the treatment they recieved. Results Operations were successful in all 40 patients. There were two cases of perioperative death(5%). And none of pa?tients died in TEVAR group during follow-up. One case among 11 patients who received conservative treatment dead in hos?pital(9.1%)while other 7 cases died during follow-up(63.6%). Kaplan-Meier survival curve showed that two-year survival rate of TEVAR group was significantly higher than that of conservative group. In TEVAR group, the maximum diameter of the aorta presented a decreasing trend and thrombosis was seen in artificial lumen with time going after operation. Conclu?sion For patients with Stanford type B aortic dissection, TEVAR presented a high success rate and promoted remodeling of the aortic genuine and aritificial lumen. What’s more, it can significantly improve patient’s survival rate and recovery in short or mid-term period compared with effect of traditional conservative treatment.
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Objective To investigate the indications and efficacy of endovascular stenting for the treatment of thoracic aortic aneurysm.Methods From March 2005 to October 2008,21 patients with Stanford type B aortic dissection,5 cases of pseudoaneurysm,and 2 patient with intramural hematoma complicated with ulcer of the aortic wall were treated by endovascular stenting under general(2 cases) or local(26 cases) anesthesia in our hospital.Medtronic Talent stent was employed in 10 cases,Medtronic Valiant stent was used in 12,and microinvasive straight-type stent was used in 6 patients.Results The operation was completed successfully in all of the 28 cases.Angiography showed that the gaps in the aorta were closed without endoleak.No patient had chest pain or neurological complications.The patients were discharged in(4.5?1.1) days(range 3-7 days).Five patients developed fever after the operation and were cured by indomethacin in one month.One week after the surgery,in 21 cases,CT scan showed enlarged aortic dissection,improved blood supply,thrombus in the false lumen of the thoracic aorta,and a false lumen in the abdominal aorta.In the 5 cases with pseudoaneurysm,CT scan confirmed that the rupture was closed with thrombus being detected in the lumen.The aortic ulcers that were detected in the 2 cases,who had intramural hematoma,were covered by the stents.Of the patients,a follow-up of(21.3?10.2) months(range 1-40 months) was available in 23 patients,who had no complications during the period.Conclusions Endovascular stenting is a simple,safe and effective method for Stanford type B aortic dissection,pseudoaneurysm,and intramural hematoma,resulting in quick recovery,less complications,and short hospital stay.