Objective: To Compare the effects and safety of lumen reshaping after thoracic endovascular aortic repair (TEVAR) for Stanford B type aortic dissection (AD) at different intervention times. Methods: A retrospective analysis was conducted on the clinical data of 189 patients with Stanford type B aortic dissection treated with TEVAR at the Affiliated Hospital of Chengde Medical College from January 2016 to December 2020.Based on the time from onset to surgery, patients were divided into an early intervention group (≤14 days, n=127) and a delayed intervention group (>14 days, n=62).The diameters of the total aorta, true lumen and false lumen at different times and planes (S1 plane: at the bifurcation of the pulmonary artery; S2 plane: at the lower edge of the left atrium; S3 plane: at the upper edge of the celiac trunk) post-surgery were compared between the two groups, and the rate of change in diameters of true and false lumens across these planes was calculated. The patients were followed until December 1st, 2023, and the median follow-up time was 45(40, 49) months. The postoperative complications and survival of the two groups were compared. Results: The early intervention group comprised 86 men and 41 women, with an average age of (58.3±10.7) years. The delayed intervention group included 41 men and 21 women, with an average age of (58.5±9.2) years. Both groups had an operation success rate of 100%. Six months post-surgery, the early intervention group had an expansion rate of the true lumen diameter at planes S2 and S3 of 40.1%(25.5%, 56.1%) and 5.3%(-2.5%, 15.8%), respectively, which was superior to the delayed intervention group's 18.5%(10.6%, 39.8%) and 1.0%(-8.2%, 9.6%) (both P<0.05).The early intervention group had a reduction rate of the false lumen diameter at planes S1, S2, and S3 of -56.2%(-61.3%, -48.8%), -70.4%(-81.8%, -56.6%), and -5.4%(-17.4%, 0.1%), respectively, better than the delayed intervention group's -44.2%(-53.7%, -38.3%), -49.0%(-57.6%, -35.8%), and -3.1%(-6.7%, 1.8%) (all P<0.05).At plane S1, the true lumen diameter of patients in both groups showed an increasing trend over 36 months post-surgery, while the false lumen diameter showed a decreasing trend (both P<0.05).At plane S2, the true lumen diameter of patients in the early intervention group exhibited an increasing trend over 36 months post-surgery, and the false lumen diameter exhibited a decreasing trend (both P<0.05).At plane S3, the total aortic diameter of patients in the delayed intervention group showed a slight increasing trend over 36 months post-surgery (P<0.05).The overall survival time were 45.0 months (95%CI: 42.9-47.1) for patients in the early intervention group and 46.0 months (95%CI: 43.5-48.5) for those in the delayed intervention group, with no statistically significant difference observed (P>0.05).The incidence rates of complications such as aortic rupture, retrograde Type A dissection, new distal endograft dissection, endoleak, paraplegia, and others showed no statistically significant difference between the two groups (all P>0.05), with no cases of stent migration or deformation observed. Conclusion: Early intervention for Stanford type B aortic dissection provides a better aortic remodeling outcome than delayed intervention, with similar safety.
目的： 比较不同干预时机的Stanford B型主动脉夹层（AD）胸主动脉腔内修复（TEVAR）术后管腔重塑的效果及安全性。 方法： 回顾性分析2016年1月至2020年12月承德医学院附属医院行TEVAR治疗的189例Stanford B型AD患者临床资料。根据患者发病至手术时间分为早期干预组（≤14 d，n=127）和延迟干预组（>14 d，n=62）。比较两组患者术后不同时间、不同平面（S1平面：肺动脉分叉处平面；S2平面：左心房下缘处平面；S3平面：腹腔干上缘处平面）全主动脉、真腔与假腔直径的差异，并计算不同平面真假腔直径变化率。随访截至2023年12月1日，中位随访时间45（40，49）个月，比较两组患者随访期间并发症及生存情况。 结果： 早期干预组男86例，女41例，年龄（58.3±10.7）岁；延迟干预组男41例，女21例，年龄（58.5±9.2）岁。两组患者手术成功率均为100%。术后6个月，早期干预组在S2、S3平面的真腔直径扩大率分别为40.1%（25.5%，56.1%）、5.3%（-2.5%，15.8%），优于延迟干预组的18.5%（10.6%，39.8%）、1.0%（-8.2%，9.6%）（均P<0.05）；早期干预组在S1、S2、S3平面的假腔直径减小率分别为-56.2%（-61.3%，-48.8%）、-70.4%（-81.8%，-56.6%）、-5.4%（-17.4%，0.1%），优于延迟干预组的-44.2%（-53.7%，-38.3%）、-49.0%（-57.6%，-35.8%）、-3.1%（-6.7%，1.8%）（均P<0.05）。在S1平面，两组患者术后36个月内的真腔直径随时间呈增大趋势，假腔直径随时间呈减小趋势（均P<0.05）。在S2平面，早期干预组患者在术后36个月内的真腔直径随时间呈增大趋势，假腔直径随时间呈减小趋势（均P<0.05）。在S3平面，延迟干预组患者在术后36个月内的全主动脉直径随时间呈略增大趋势（P<0.05）。早期干预组患者中位总生存时间为45.0（95%CI：42.9~47.1）个月，延迟干预组为46.0（95%CI：43.5~48.5）个月，差异无统计学意义（P>0.05）。两组患者主动脉破裂、逆撕A型夹层、支架远端新发夹层、内漏、截瘫等并发症发生率差异均无统计学意义（均P>0.05），均未出现支架移位、变形。 结论： 早期干预Stanford B型AD较延迟干预有着更好的主动脉重塑结局，并且二者安全性相似。.