초록접수 현황
| 15F-173 | 구연 발표 |
Mid-term Results and Prognostic Factor of Aorta Remodeling Analysis after TEVAR in CDIIIb Patients.
송석원¹, 김태훈¹, 이광훈², 유경종³
연세대학교 의과대학 강남세브란스병원 심장혈관외과¹, 연세대학교 의과대학 강남세브란스병원 영상의학과², 연세대학교 의과대학 세브란스병원 심장혈관외과³
Background : The use of thoracic endovascular aortic repair (TEVAR) for chronic DeBakey III type b (CDIIIb) aneurysms is controversial. We analyzed mid-term results and prognostic factors affecting aorta remodeling after this procedure.
Methods : From 2012 to 2015, Fifty-five patients (Mean age, 56.4 ±12.4 years) with CDIIIb underwent TEVAR, with full coverage of reentry tears at the descending thoracic aorta. The potential factors affecting false lumen(FL) remodeling, mortality and complications were analyzed. The aortic remodelings were measured as degree of thrombosis and diameter change of false lumen(FL). The diameters were measured at the 3 levels (left subclavian artery, pulmonary artery bifurcation, and celiac artery).
Results : There was no permanent spinal cord injury, stroke and 30-day mortality. All patients were followed up with mean duration of 18.4 months. Ten patients (18.2%) required reintervention during the follow-up period. Twenty-nine patients (52.7%) had complete thrombosis of the FL at stent graft segment. Forty six patients (83.6%) had complete thrombosis of FL at the mid-thoracic level. Compared with the complete thrombosis group at the stent level, the partial thrombosis group had more reentry tears (1.3 vs 2.7, P = .014), large intimal tears (0.7 vs 1.0, P =.149), visceral branches arising from the FL (1.1 vs 1.6, P =.097), and ICAs arising from the FL (3.6 vs 5.7, P = .013).After multivariate analysis, Visceral branches and ICAs arising from the FL were significant negative prognostic factors for FL complete thrombosis and shrinkage (P < .05).
Conclusion : TEVAR in CDIIIb patients showed the favorable results. Although reentry tears above the celiac trunk were fully covered, the visceral branches and ICAs from the FL below the celiac trunk kept the FL pressurized and were unfavorable prognostic factors for aorta remodeling after TEVAR for CDIIIb aneurysms. Further study is warranted for long-term prognosis and aorta remodeling after TEVAR.
Methods : From 2012 to 2015, Fifty-five patients (Mean age, 56.4 ±12.4 years) with CDIIIb underwent TEVAR, with full coverage of reentry tears at the descending thoracic aorta. The potential factors affecting false lumen(FL) remodeling, mortality and complications were analyzed. The aortic remodelings were measured as degree of thrombosis and diameter change of false lumen(FL). The diameters were measured at the 3 levels (left subclavian artery, pulmonary artery bifurcation, and celiac artery).
Results : There was no permanent spinal cord injury, stroke and 30-day mortality. All patients were followed up with mean duration of 18.4 months. Ten patients (18.2%) required reintervention during the follow-up period. Twenty-nine patients (52.7%) had complete thrombosis of the FL at stent graft segment. Forty six patients (83.6%) had complete thrombosis of FL at the mid-thoracic level. Compared with the complete thrombosis group at the stent level, the partial thrombosis group had more reentry tears (1.3 vs 2.7, P = .014), large intimal tears (0.7 vs 1.0, P =.149), visceral branches arising from the FL (1.1 vs 1.6, P =.097), and ICAs arising from the FL (3.6 vs 5.7, P = .013).After multivariate analysis, Visceral branches and ICAs arising from the FL were significant negative prognostic factors for FL complete thrombosis and shrinkage (P < .05).
Conclusion : TEVAR in CDIIIb patients showed the favorable results. Although reentry tears above the celiac trunk were fully covered, the visceral branches and ICAs from the FL below the celiac trunk kept the FL pressurized and were unfavorable prognostic factors for aorta remodeling after TEVAR for CDIIIb aneurysms. Further study is warranted for long-term prognosis and aorta remodeling after TEVAR.
첨부파일 : Figure-CDIIIb.ppt
책임저자: 송석원
연세대학교 의과대학 강남세브란스병원 심장혈관외과
연락처 : 송석원, Tel: 010-3324-2076 , E-mail : sevraphd@yuhs.ac
