B 型主动脉夹层患者血管内治疗后的生存情况：国际急性主动脉夹层注册研究（IRAD）的报告。
Survival after endovascular therapy in patients with type B aortic dissection: a report from the International Registry of Acute Aortic Dissection (IRAD).
机构信息
Interventional Cardiology Unit, San Salvatore Hospital, Pesaro, Italy.
出版信息
JACC Cardiovasc Interv. 2013 Aug;6(8):876-82. doi: 10.1016/j.jcin.2013.05.003.
OBJECTIVES
This study sought to evaluate long-term survival in type B aortic dissection patients treated with thoracic endovascular aortic repair (TEVAR) therapy.
BACKGROUND
Historical data have supported medical therapy in type B acute aortic dissection (TBAAD) patients. Recent advances in TEVAR appear to improve in-hospital mortality.
METHODS
We examined 1,129 consecutive patients with TBAAD enrolled in IRAD (International Registry of Acute Aortic Dissection) between 1995 and 2012 who received medical (n = 853, 75.6%) or TEVAR (n = 276, 24.4%) therapy.
RESULTS
Clinical history was similar between groups. TEVAR patients were more likely to present with a pulse deficit (28.3% vs. 13.4%, p < 0.001) and lower extremity ischemia (16.8% vs. 3.6%, p < 0.001), and to characterize their pain as the "worst pain ever" (27.5% vs. 15.7%, p < 0.001). TEVAR patients were also most likely to present with complicated acute aortic dissection, defined as shock, periaortic hematoma, signs of malperfusion, stroke, spinal cord ischemia, mesenteric ischemia, and/or renal failure (61.7% vs. 37.2%). In-hospital mortality was similar in patients managed with endovascular repair (10.9% vs. 8.7%, p = 0.273) compared with medically managed patients. One-year mortality was also similar in both groups (8.1% endovascular vs. 9.8% medical, p = 0.604). Among adverse events during follow-up, aortic growth/new aneurysm was most common, occurring in 73.3% of patients with medical therapy and in 62.7% of patients after TEVAR, based on 5-year Kaplan-Meier estimates. Kaplan-Meier survival estimates showed that patients undergoing TEVAR had a lower death rate (15.5% vs. 29.0%, p = 0.018) at 5 years.
CONCLUSIONS
Results from IRAD show that TEVAR is associated with lower mortality over a 5-year period than medical therapy for TBAAD. Further randomized trials with long-term follow-up are needed.
目的
本研究旨在评估接受胸主动脉腔内修复术（TEVAR）治疗的 B 型主动脉夹层（B型急性主动脉夹层，TBAAD）患者的长期生存情况。
背景
历史数据支持 B 型急性主动脉夹层（TBAAD）患者的内科治疗。TEVAR 的最新进展似乎改善了住院死亡率。
方法
我们检查了 1995 年至 2012 年期间 IRAD（国际急性主动脉夹层注册研究）连续登记的 1129 例 TBAAD 患者，其中接受内科治疗（n = 853，75.6%）或 TEVAR（n = 276，24.4%）治疗。
结果
两组的临床病史相似。TEVAR 患者更可能出现脉搏缺失（28.3% vs. 13.4%，p < 0.001）和下肢缺血（16.8% vs. 3.6%，p < 0.001），并将其疼痛描述为“有史以来最严重的疼痛”（27.5% vs. 15.7%，p < 0.001）。TEVAR 患者也更有可能出现复杂的急性主动脉夹层，定义为休克、主动脉周围血肿、灌注不良迹象、中风、脊髓缺血、肠系膜缺血和/或肾衰竭（61.7% vs. 37.2%）。血管内修复治疗的住院死亡率与内科治疗患者相似（10.9% vs. 8.7%，p = 0.273）。两组的 1 年死亡率也相似（血管内治疗组 8.1%，内科治疗组 9.8%，p = 0.604）。在随访期间的不良事件中，最常见的是主动脉生长/新动脉瘤，接受内科治疗的患者中有 73.3%发生，接受 TEVAR 治疗的患者中有 62.7%发生，基于 5 年 Kaplan-Meier 估计。Kaplan-Meier 生存估计显示，TEVAR 组患者的死亡率较低（5 年时为 15.5% vs. 29.0%，p = 0.018）。
结论
IRAD 的结果表明，与 TBAAD 的内科治疗相比，TEVAR 在 5 年内与较低的死亡率相关。需要进一步进行具有长期随访的随机试验。
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