Application and analysis of abdominal aortic branch malperfusion pattern in thoracic endovascular aortic repair for Stanford B aortic dissection / 北京大学学报(医学版)

ABSTRACT

Objective:To evaluate the efficiency of thoracic endovascular aortic repair (TEVAR) in dealing with abdominal aortic branch malperfusion based on the analysis of aortic computed tomography angiography (CTA) images in pre-and post-TEVAR.Methods:Retrospective analysis from September 2015 to March 2016 in single institution to 32 patients,diagnosed as Stanford B aortic dissection with abdominal aortic branch malperfusion,CTA images in pre-and post-TEVAR were collected.Based on the aortic branch malperfusion pattern redefined by Nagamine,we identified and characterized branch malperfusion pattern for four abdominal aortic branches (celiac trunk,superior mesenteric artery,bilateral renal artery) in statistical analysis.Results:In the four abdominal aortic branches (total 128 branches),86 branches (67.2％) expressed with Class Ⅰ patterns,in which subtype Ⅰ-b presented with 0.8％,subtype Ⅰ-c with 5.5％;14 branches (10.9％) expressed with Class Ⅱ patterns,in which subtype Ⅱ-b-1 with 3.9％,subtype Ⅱ-b-2 with 3.1％;16 branches (12.5％) expressed with Class Ⅲ patterns,all with subtype Ⅲ-a,no subtype Ⅲ-b and Ⅲ-c presented.The remaining 12 branches were normal.The 100％ successful rate of TEVAR obtained in 32 patients performed.The mean following-up was 4 months.Aortic CTA showed that among the 14 "high-risk" abdominal aortic branch malperfusion,13 (92.9％) with obvious branch malperfusion in post-TEVAR were observed to improve,and the remaining one branch malperfusion (7.1％) was observed to change from subtype Ⅰ-b to Ⅰ-c.Conclusion:Few ratios in abdominal aortic branches suffered with obvious malperfusion complicated by Stanford B aortic dissection.For branches with "high-risk" malperfusion pattern,optimal changes were observed in abdominal aortic branch without revascularization in post-TEVAR,as well other branches with non-" high-risk" pattern perfusion were mostly stable in post-TEVAR.It could be of profound benefit to extend branch malperfusion patterns redefined by Nagamine in clinical practice to assess aortic dissection and in further guide for revascularization or not.