Optimal medical treatment versus endovascular aortic repair in uncomplicated isolated abdominal aortic dissection

医学 四分位间距 外科 主动脉夹层 回顾性队列研究 单变量分析 解剖(医学) 主动脉修补术 病历 腹部外科 动脉瘤 内科学 主动脉 多元分析
作者
Sheng Su,Jitao Liu,Changjin Wang,Rui-Rong Chen,Yuanli Liu,Wenhui Huang,Songyuan Luo,Fan Yang,Jianfang Luo
出处
期刊:Journal of Vascular Surgery [Elsevier BV]
卷期号:77 (4): 1028-1036.e2
标识
DOI:10.1016/j.jvs.2022.10.036
摘要

To report the results of optimal medical treatment (OMT) and endovascular aortic repair (EVAR) in patients with uncomplicated isolated abdominal aortic dissection (IAAD).A retrospective review of 96 consecutive patients with uncomplicated IAAD (uIAAD) managed at a single tertiary vascular unit between January 2011 and July 2021 was conducted. Standard methods for univariate and survival analyses were used. The primary outcomes were all-cause mortality. Secondary end points included uIAAD progression, interventional complications, and follow-up aortic intervention.Initially, 53.1% of patients (51/96) were managed with OMT. No in-hospital deaths occurred. During follow-up, three patients died, and three and two patients who were initially managed with OMT subsequently required endovascular treatment and surgical management, respectively. Initially, 46.9% of patients (45/96) underwent EVAR. One patient died during hospital admission; nine patients had an endoleak after operation and one needed reintervention. Furthermore, during follow-up, five patients died; four patients needed reoperation, one surgery and three endovascular treatments. The overall long-term mortality was 8.4%, and follow-up aortic intervention rate was 9.5% (median follow-up, 54 months; interquartile range, 33-81 months) with no significant difference between groups. Of note, 12 patients (12.6%) suffered uIAAD progression, which was higher in the OMT group than EVAR group (10 [19.6%] vs 2 [4.5%]; P = .03).uIAAD may be managed safely by OMT with regular surveillance, despite the risk of disease progression. Compared with OMT, EVAR could significantly prevent uIAAD progression. For anatomically suitable patients with uIAAD progression and who are unresponsive to OMT, pre-emptive EVAR is a safe and feasible option.
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