Uncomplicated急性B型解離に対する亜急性期Preemptive TEVARの成績と瘤径変化関連因子の検討
【目的】亜急性期preemptive TEVAR（PTEVAR）の成績と瘤径変化関連因子について考察した．【方法】対象は38例，TEVAR 1年後の瘤径縮小S群32例と瘤径拡大N群6例に分け，術前および術後因子，CT評価（Parsa分類）について検討した．【結果】統計学的有意な瘤径変化に関与する因子はS群で術前re-entry，術後6カ月以内の偽腔消失，Parsa分類3，N群で術前の腸骨領域re-entry，偽腔全開存，中枢landingがzone 2，術後type Ia EL，type V EL，Parsa分類0であった．追加治療に関して，N群では中枢側に2例，S群では末梢側に1例，さらにr...
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| Published in | 日本血管外科学会雑誌 Vol. 32; no. 1; pp. 13 - 18 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本血管外科学会
20.01.2023
日本血管外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0918-6778 1881-767X |
| DOI | 10.11401/jsvs.22-00083 |
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| Abstract | 【目的】亜急性期preemptive TEVAR（PTEVAR）の成績と瘤径変化関連因子について考察した．【方法】対象は38例，TEVAR 1年後の瘤径縮小S群32例と瘤径拡大N群6例に分け，術前および術後因子，CT評価（Parsa分類）について検討した．【結果】統計学的有意な瘤径変化に関与する因子はS群で術前re-entry，術後6カ月以内の偽腔消失，Parsa分類3，N群で術前の腸骨領域re-entry，偽腔全開存，中枢landingがzone 2，術後type Ia EL，type V EL，Parsa分類0であった．追加治療に関して，N群では中枢側に2例，S群では末梢側に1例，さらにre-entry閉鎖を要した症例を各々に1例認めた．【結論】亜急性期PTEVARは有効であったが，広範囲な解離，zone 2 landing，広範囲偽腔残存例では，瘤径が縮小しない傾向にあった． |
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| AbstractList | 【目的】亜急性期preemptive TEVAR（PTEVAR）の成績と瘤径変化関連因子について考察した．【方法】対象は38例，TEVAR 1年後の瘤径縮小S群32例と瘤径拡大N群6例に分け，術前および術後因子，CT評価（Parsa分類）について検討した．【結果】統計学的有意な瘤径変化に関与する因子はS群で術前re-entry，術後6カ月以内の偽腔消失，Parsa分類3，N群で術前の腸骨領域re-entry，偽腔全開存，中枢landingがzone 2，術後type Ia EL，type V EL，Parsa分類0であった．追加治療に関して，N群では中枢側に2例，S群では末梢側に1例，さらにre-entry閉鎖を要した症例を各々に1例認めた．【結論】亜急性期PTEVARは有効であったが，広範囲な解離，zone 2 landing，広範囲偽腔残存例では，瘤径が縮小しない傾向にあった． 「要旨」 : 【目的】亜急性期preemptive TEVAR (PTEVAR) の成績と瘤径変化関連因子について考察した. 【方法】対象は38例, TEVAR1年後の瘤径縮小S群32例と瘤径拡大N群6例に分け, 術前および術後因子, CT評価 (Parsa分類) について検討した. 【結果】統計学的有意な瘤径変化に関与する因子はS群で術前re-entryなし, 術後6カ月以内の偽腔消失, Parsa分類3, N群で術前の腸骨領域re-entry, 偽腔全開存, 中枢landingがzone 2, 術後type Ia EL, type V EL, Parsa分類0であった. 追加治療に関して, N群では中枢側に2例, S群では末梢側に1例, さらにre-entry閉鎖を要した症例を各々に1例認めた. 【結論】亜急性期PTEVARは有効であったが, 広範囲な解離, zone 2 landing, 広範囲偽腔残存例では, 瘤径が縮小しない傾向にあった. |
| Author | 緑川, 博文 堀田, 明敬 滝浪, 学 植野, 恭平 太田, 和寛 菅野, 恵 |
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| References | 8) Li DL, He YJ, Wang XH, et al. Long-term results of thoracic endovascular aortic repair for type B aortic dissection and risk factors for surviaval. J Endovasc Ther 2020; 27: 358–367. 14) Hughes CG, Ganapathi AM, Keenan E, et al. Thoracic endovascular aortic repair for chronic DeBakey IIIb aortic dissection. Ann Thorac Surg 2014; 98: 2092–2098; discussion, 2098. 15) Matsushita A, Tabata M, Mihara W, et al. Risk score system for late aortic events in patients with uncomplicated type B aortic dissection. J Thorac Cardiovasc Surg 2020; 159: 2173–2183.e1. 6) Hossack M, Patel S, Gambardella I, et al. Endovascular vs medical management for uncomplicated acute and subacute type B aortic dissection: a meta-analysis. Eur J Vasc Endovasc Surg 2020; 59: 794–807. 18) Ho JYK, Chow SCY, Kwok MWT, et al. Total aortic arch replacement and frozen elephant trunk. Semin Thorac Cardiovasc Surg 2020; 33: 656–662. 11) The VIRTUE Registry Investigators. Mid-term outcomes and aortic remodeling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE Registry. Eur J Vasc Endovasc Surg 2014; 48: 363–371. 3) Zeeshan A, Woo EY, Bavaria JE, et al. Thoracic endovascular aortic repair for acute complicated type B aortic dissection: superiority relative to conventional open surgical and medical therapy. J Thorac Cardiovasc Surg 2010; 140 Suppl: S109–S115; discussion, S142–S146. 5) Parsa CJ, Schroder JN, Daneshmand MA. Midterm results for endovascular repair of complicated acute and chronic type B aortic dissection. Ann Thorac Surg 2010; 89: 97–104; discussion, 102–104. 17) Ueki C, Tsuneyoshi H. Late aortic expansion after thoracic endovascular aortic repair for chronic DeBakey IIIb dissection. Ann Thorac Surg 2021; 111: 1271–1277. 7) Peterss S, Mansour AM, Ross JA, et al. Changing pathology of the thoracic aorta from acute to chronic dissection: literature review and insights. J Am Coll Cardiol 2016; 68: 1054–1065. 13) Rodriguez JA, Olsen DM, Lucas L, et al. Aortic remodeling after endografting of thoracoabdominal aortic dissection. J Vasc Surg 2008; 47: 1188–1194. 4) 緑川博文，菅野, 恵，高野隆志，他．Zone 2（Z2）に対するTEVARの初期および中期成績—鎖骨下動脈はどうすべきか？—．日心外会誌2013; 42: 6–10. 16) Li Z, Xu H, Armour CH, et al. The Necessity to seal the re-entry tears of aortic dissection after TEVAR: a hemodynamic indicator. Front Bioeng Biotechnol 2022; 10, article 831903. 2) Nienaber CA, Kische S, Rousseau H, et al.; INSTEAD-XL trial. Endovascular repair of type B aortic dissection: long term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv 2013; 6: 407–416. 1) 日本循環器学会．循環器病の診断と治療に関するガイドライン（2020年度合同研究班報告）：大動脈瘤・大動脈解離診療ガイドライン（2020年改訂版） 10) Luebke T, Brunkwall J. Type B aortic dissection: a review of prognostic factors and meta-analysis of treatment options. Aorta 2014; 2: 265–278. 9) Torrent DJ, McFarland GE, Wang G, et al. Timing of thoracic endovascular aortic repair for uncomplicated acute type B aortic dissection and the association with complications. J Vasc Surg 2021; 73: 826–835. 12) Mizoguchi T, Zempo N, Kaneda Y. Early and mid-term outcomes following TEVAR for chronic type B aortic dissection. Ann Vasc Dis 2017; 10: 345–350. |
| References_xml | – reference: 6) Hossack M, Patel S, Gambardella I, et al. Endovascular vs medical management for uncomplicated acute and subacute type B aortic dissection: a meta-analysis. Eur J Vasc Endovasc Surg 2020; 59: 794–807. – reference: 5) Parsa CJ, Schroder JN, Daneshmand MA. Midterm results for endovascular repair of complicated acute and chronic type B aortic dissection. Ann Thorac Surg 2010; 89: 97–104; discussion, 102–104. – reference: 7) Peterss S, Mansour AM, Ross JA, et al. Changing pathology of the thoracic aorta from acute to chronic dissection: literature review and insights. J Am Coll Cardiol 2016; 68: 1054–1065. – reference: 1) 日本循環器学会．循環器病の診断と治療に関するガイドライン（2020年度合同研究班報告）：大動脈瘤・大動脈解離診療ガイドライン（2020年改訂版）． – reference: 3) Zeeshan A, Woo EY, Bavaria JE, et al. Thoracic endovascular aortic repair for acute complicated type B aortic dissection: superiority relative to conventional open surgical and medical therapy. J Thorac Cardiovasc Surg 2010; 140 Suppl: S109–S115; discussion, S142–S146. – reference: 4) 緑川博文，菅野, 恵，高野隆志，他．Zone 2（Z2）に対するTEVARの初期および中期成績—鎖骨下動脈はどうすべきか？—．日心外会誌2013; 42: 6–10. – reference: 2) Nienaber CA, Kische S, Rousseau H, et al.; INSTEAD-XL trial. Endovascular repair of type B aortic dissection: long term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv 2013; 6: 407–416. – reference: 15) Matsushita A, Tabata M, Mihara W, et al. Risk score system for late aortic events in patients with uncomplicated type B aortic dissection. J Thorac Cardiovasc Surg 2020; 159: 2173–2183.e1. – reference: 11) The VIRTUE Registry Investigators. Mid-term outcomes and aortic remodeling after thoracic endovascular repair for acute, subacute, and chronic aortic dissection: the VIRTUE Registry. Eur J Vasc Endovasc Surg 2014; 48: 363–371. – reference: 18) Ho JYK, Chow SCY, Kwok MWT, et al. Total aortic arch replacement and frozen elephant trunk. Semin Thorac Cardiovasc Surg 2020; 33: 656–662. – reference: 8) Li DL, He YJ, Wang XH, et al. Long-term results of thoracic endovascular aortic repair for type B aortic dissection and risk factors for surviaval. J Endovasc Ther 2020; 27: 358–367. – reference: 9) Torrent DJ, McFarland GE, Wang G, et al. Timing of thoracic endovascular aortic repair for uncomplicated acute type B aortic dissection and the association with complications. J Vasc Surg 2021; 73: 826–835. – reference: 12) Mizoguchi T, Zempo N, Kaneda Y. Early and mid-term outcomes following TEVAR for chronic type B aortic dissection. Ann Vasc Dis 2017; 10: 345–350. – reference: 13) Rodriguez JA, Olsen DM, Lucas L, et al. Aortic remodeling after endografting of thoracoabdominal aortic dissection. J Vasc Surg 2008; 47: 1188–1194. – reference: 10) Luebke T, Brunkwall J. Type B aortic dissection: a review of prognostic factors and meta-analysis of treatment options. Aorta 2014; 2: 265–278. – reference: 14) Hughes CG, Ganapathi AM, Keenan E, et al. Thoracic endovascular aortic repair for chronic DeBakey IIIb aortic dissection. Ann Thorac Surg 2014; 98: 2092–2098; discussion, 2098. – reference: 17) Ueki C, Tsuneyoshi H. Late aortic expansion after thoracic endovascular aortic repair for chronic DeBakey IIIb dissection. Ann Thorac Surg 2021; 111: 1271–1277. – reference: 16) Li Z, Xu H, Armour CH, et al. The Necessity to seal the re-entry tears of aortic dissection after TEVAR: a hemodynamic indicator. Front Bioeng Biotechnol 2022; 10, article 831903. |
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| Snippet | 【目的】亜急性期preemptive TEVAR（PTEVAR）の成績と瘤径変化関連因子について考察した．【方法】対象は38例，TEVAR 1年後の瘤径縮小S群32例と瘤径拡大N群6例に分け，術... 「要旨」 : 【目的】亜急性期preemptive TEVAR (PTEVAR) の成績と瘤径変化関連因子について考察した. 【方法】対象は38例, TEVAR1年後の瘤径縮小S群32例と瘤径拡大N群6例に分け,... |
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| Title | Uncomplicated急性B型解離に対する亜急性期Preemptive TEVARの成績と瘤径変化関連因子の検討 |
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