机构:[1]Department of Vascular Surgery, The First Hospital Affiliated to Kunming Medical University, Kunming Medical University, Kunming, Yunnan, PR China外科科室普通外科普通外三科(血管外科)昆明医科大学附属第一医院[2]Division of Vascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong Special Administrative Region
Objectives: Despite technically successful thoracic endovascular stent graft repair (TEVAR) in patients with Stanford Type B aortic dissection (TBAD), long-term follow up studies have shown that the false lumen may continue to dilate. The aim of this study was to analyze the possible mechanisms leading to such changes from a hemodynamic perspective. Methods: Twenty-eight ex vivo fresh porcine TBAD models (Mo A: 10; Model B: 12; Model C: 6) were established to simulate three clinical situations: Model A with patent false lumen (pre-TEVAR); Model B with distal re-entry only (post-TEVAR), and Model C with thrombus filling in the false lumen and a distal re-entry (chronic stage of post-TEVAR). Synchronous pressure waveforms were taken from both the true and the false lumen. True lumen and false lumen pressure differences were calculated for each model as four indices: systolic index (SI), diastolic index (DI), mean pressure index (MPI) and area under curve index (AUCI). These indices were compared between the three models. Results: False lumen pressure and corresponding pressure-accumulating effects were significantly higher in Model A than in Model C: SI (99.9% vs. 189.4%; p < .001); MPI and AUCI (99.5% vs. 128.2%; 99.5% vs. 128%; p < .001). The SI, MPI, and AUCI were significantly higher in Model B compared with Model C. The differences between the four indices were not significant between Model A and B. The false lumen area under curve (AUC) in Model C was merely lowered by 20% compared with its true lumen (67.5 mmHg vs. 85.2 mmHg). Conclusion: The false lumen pressure remained unchanged in the non-thrombosed segment with patent blood flow after the primary entry tear sealed. Intraluminal pressure reduction in the thrombosed false lumen was significant. However, nearly 80% of the pressure remained in the thrombosed false lumen. If this high intrathrombus pressure persists, it may contribute to delayed aneurysmal formation after endovascular treatment. (C) 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
第一作者机构:[1]Department of Vascular Surgery, The First Hospital Affiliated to Kunming Medical University, Kunming Medical University, Kunming, Yunnan, PR China
通讯作者:
通讯机构:[*1]Division of Vascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, Hong Kong Special Administrative Region
推荐引用方式(GB/T 7714):
Qing K. -X.,Chan Y. -C.,Ting A. C. W.,et al.Persistent Intraluminal Pressure After Endovascular Stent Grafting for Type B Aortic Dissection[J].EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY.2016,51(5):656-663.doi:10.1016/j.ejvs.2016.01.006.
APA:
Qing, K. -X.,Chan, Y. -C.,Ting, A. C. W.&Cheng, S. W. K..(2016).Persistent Intraluminal Pressure After Endovascular Stent Grafting for Type B Aortic Dissection.EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY,51,(5)
MLA:
Qing, K. -X.,et al."Persistent Intraluminal Pressure After Endovascular Stent Grafting for Type B Aortic Dissection".EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 51..5(2016):656-663