초록접수 현황
| 15F-174 | 구연 발표 |
Effects of False Lumen Procedures on Aorta Remodeling of Chronic DeBakey IIIb Aneurysm
김태훈¹, 송석원¹, 이광훈², 유경종³
연세대학교 의과대학 강남세브란스병원 심장혈관외과¹, 연세대학교 의과대학 강남세브란스병원 영상의학과², 연세대학교 의과대학 세브란스병원 심장혈관외과³
Background : Although thoracic endovascular aortic repair (TEVAR) is widely used in chronic DeBakey IIIb aneurysm (CDIIIb), persistent retrograde flow to the false lumen(FL) through distal reentry tears is a main cause of failure. We sought to determine the safety and efficacy of false lumen procedures(FLP) on aorta remodeling in these patients.
Methods : From 2012 to 2015, 25 patients (Mean age, 55.2±11.2 years) with CDIIIb underwent FLP using vascular plugs, stent grafts, coils or glues. Thirteen patients had CDIIIb and twelve patients had residual CDIIIb after prior type A repair. FLP was done as an adjunctive procedure after initial TEVAR in 10 patients, with initial TEVAR in 12 patients and as an isolated procedure in 3 patients. The outcomes were measured as degree of thrombosis and diameter change of the true and false lumen(TL and FL). The diameters were measured at the 3 levels (left subclavian artery, pulmonary artery bifurcation, and celiac artery).
Results : There was no spinal cord injury, stroke, renal failure and 30-day mortality. All patients were followed up with mean duration of 15 months. One patient died at 7 month postoperatively due to intra-ventricular hemorrhage. There was no death directly due to aortic complication. Complete thrombosis of FL was observed in 20 (80%) patients after FLP. Incomplete thrombosis of FL was observed in 5(20%) patients including 2(8%) patients who had short follow up duration, 2(8%) patients with FLP targeting proximal reentry and 1(4%) patient with visceral procedure. Compared to pre-FLP, the mean diameter of false lumen for 3 levels (Pre Vs. Post; 22.23±10.18 mmVs.17.56±10.84 mm, p<0.001) was significantly decreased and the mean diameter of true lumen for 3 levels (20.45±5.33 mm Vs. 25.12±5.60 mm, p<0.001) was increased.(Fig.1) The expansion and regression rate of the TL and FL diameter after FLP were comparable to patients who underwent TEVAR. (Table 1)
Conclusion : False lumen procedures with various materials were safe and promoted complete thrombosis and favorable aorta remodeling in patients with CDIIIb. Further large study of this strategy is warranted.
Methods : From 2012 to 2015, 25 patients (Mean age, 55.2±11.2 years) with CDIIIb underwent FLP using vascular plugs, stent grafts, coils or glues. Thirteen patients had CDIIIb and twelve patients had residual CDIIIb after prior type A repair. FLP was done as an adjunctive procedure after initial TEVAR in 10 patients, with initial TEVAR in 12 patients and as an isolated procedure in 3 patients. The outcomes were measured as degree of thrombosis and diameter change of the true and false lumen(TL and FL). The diameters were measured at the 3 levels (left subclavian artery, pulmonary artery bifurcation, and celiac artery).
Results : There was no spinal cord injury, stroke, renal failure and 30-day mortality. All patients were followed up with mean duration of 15 months. One patient died at 7 month postoperatively due to intra-ventricular hemorrhage. There was no death directly due to aortic complication. Complete thrombosis of FL was observed in 20 (80%) patients after FLP. Incomplete thrombosis of FL was observed in 5(20%) patients including 2(8%) patients who had short follow up duration, 2(8%) patients with FLP targeting proximal reentry and 1(4%) patient with visceral procedure. Compared to pre-FLP, the mean diameter of false lumen for 3 levels (Pre Vs. Post; 22.23±10.18 mmVs.17.56±10.84 mm, p<0.001) was significantly decreased and the mean diameter of true lumen for 3 levels (20.45±5.33 mm Vs. 25.12±5.60 mm, p<0.001) was increased.(Fig.1) The expansion and regression rate of the TL and FL diameter after FLP were comparable to patients who underwent TEVAR. (Table 1)
Conclusion : False lumen procedures with various materials were safe and promoted complete thrombosis and favorable aorta remodeling in patients with CDIIIb. Further large study of this strategy is warranted.
첨부파일 : figure-FLP.ppt
책임저자: 송석원
연세대학교 의과대학 강남세브란스병원 심장혈관외과
연락처 : 김태훈, Tel: 010-8581-4604 , E-mail : airtech2@naver.com
