초록접수 현황
| 14F-127 | 포럼 발표 |
Aorta Remodeling after Thoracic Endovascular Aortic Repair in Chronic DeBakey IIIb Aneurysm
김태훈, 임선희, 송석원
연세대학교 의과대학 강남세브란스병원 흉부외과학교실
Background : The pressure difference between the false lumen (FL) and true lumen (TL) with the radial force of the stent graft is known to be a main driving force of aorta remodeling after thoracic endovascular aortic repair (TEVAR) in chronic DeBakey IIIb (CDIIIb) aneurysm. We sought to find prognostic factors of aortic remodeling after this procedure
Methods : Forty one patients underwent TEVAR for CDIIIb aneurysm for 2 years. All patients had a preoperative and at least 1 postoperative CT scan after TEVAR. Our strategy in CDIIIb aneurysm is a full coverage of descending thoracic aorta just above celiac trunk. This study analyzes the following factors that may affect the aorta remodeling: (1) re-entry tears (visible communication channels between FL and TL) (2) large intimal tear below celiac trunk (visible at least 2 consecutive cuts on CT scan) (3) visceral branches arosed partially or totally from the FL (4) intercostal arteries (ICA) arosed from the FL. We measured the diameters at 3 different levels (maximum diameter of descending thoracic aorta [DTA], DTA at pulmonary artery bifurcation level, maximum diameter of abdominal aorta). All measurements were obtained by two experienced radiologists.
Results : Perioperative mortality and paraplegia was zero and re-intervention was needed in 3 cases (7.3%). Twenty four (58.5%) patients showed complete thrombosis in the FL. As compared with partial thrombosis group, the number of re-entry, large intimal tear, visceral branch arose from the FL, ICA from the FL in the complete thrombosis group was 0.96 vs. 2.18 (P < 0.05), 0.4 vs. 1.2 (P < 0.05), 0.7 vs. 2.1 (P < 0.05) and 4.4 vs. 5.6 (P = 0.138), respectively. In multivariate logistic regression analysis, visceral branches arose from the FL were negatively associated with FL thrombosis (P < 0.05). Re-entry tear is a significant unfavorable prognostic factor for the false lumen shrinkage in the DTA (P < 0.05).
Conclusion : Although all tears were covered, visceral branches from the FL and communications between the TL and FL below celiac trunk kept the false lumen pressurized, and were the unfavorable prognostic factors for aorta remodeling.
Methods : Forty one patients underwent TEVAR for CDIIIb aneurysm for 2 years. All patients had a preoperative and at least 1 postoperative CT scan after TEVAR. Our strategy in CDIIIb aneurysm is a full coverage of descending thoracic aorta just above celiac trunk. This study analyzes the following factors that may affect the aorta remodeling: (1) re-entry tears (visible communication channels between FL and TL) (2) large intimal tear below celiac trunk (visible at least 2 consecutive cuts on CT scan) (3) visceral branches arosed partially or totally from the FL (4) intercostal arteries (ICA) arosed from the FL. We measured the diameters at 3 different levels (maximum diameter of descending thoracic aorta [DTA], DTA at pulmonary artery bifurcation level, maximum diameter of abdominal aorta). All measurements were obtained by two experienced radiologists.
Results : Perioperative mortality and paraplegia was zero and re-intervention was needed in 3 cases (7.3%). Twenty four (58.5%) patients showed complete thrombosis in the FL. As compared with partial thrombosis group, the number of re-entry, large intimal tear, visceral branch arose from the FL, ICA from the FL in the complete thrombosis group was 0.96 vs. 2.18 (P < 0.05), 0.4 vs. 1.2 (P < 0.05), 0.7 vs. 2.1 (P < 0.05) and 4.4 vs. 5.6 (P = 0.138), respectively. In multivariate logistic regression analysis, visceral branches arose from the FL were negatively associated with FL thrombosis (P < 0.05). Re-entry tear is a significant unfavorable prognostic factor for the false lumen shrinkage in the DTA (P < 0.05).
Conclusion : Although all tears were covered, visceral branches from the FL and communications between the TL and FL below celiac trunk kept the false lumen pressurized, and were the unfavorable prognostic factors for aorta remodeling.
책임저자: 송석원
연세대학교 의과대학 강남세브란스병원 흉부외과학교실
연락처 : 김태훈 , Tel: 02-2019-3380 , E-mail : thkim1985@yuhs.ac
