急性Stanford B型主动脉夹层撕裂进入肠系膜上动脉时的治疗策略及疗效研究OA

Objective To investigate treatment strategies and analyze clinical outcomes based on the characteristics of morphological changes of acute Stanford type B aortic dissection extending into the superior mesenteric artery(SMA).Methods A total of 31 patients with acute Stanford type B aortic dissection extending into the SMA who underwent thoracic endovascular aortic repair(TEVAR)in the Department of Vascular Surgery,Taizhou Hospital of Zhejiang Province between January 2020 and December 2024 were retrospectively enrolled.According to the Nagamine classification and morphological features of the SMA,patients were divided into three groups:true-false lumen communication group(5 cases),patent true lumen group(18 cases),and collapsed true lumen group(8 cases).Changes in SMA-related morphological parameters before TEVAR and at 6 months after the procedure were compared among the three groups.Treatment strategies were explored,and efficacy was analyzed based on perioperative and follow-up outcomes.Results The incidence of abdominal pain in the collapsed true lumen group was significantly higher than that in the true-false lumen communication group and patent true lumen group(all P＜0.05).Meanwhile,the rates of emergency surgery and SMA reconstruction in the collapsed true lumen group were also higher than those of the true-false lumen communication group and patent true lumen group(all P＜0.05).The technical success rate reached 100.0％in all three groups.Compared with baseline,true lumen area of aorta at SMA level(SAATL)increased in the true-false lumen communication group 6 months after TEVAR(P＜0.05);in the patent true lumen group,SAATL,the proportion of aortic true lumen area,and the minimum SMA true lumen diameter all increased(all P＜0.05),whereas false lumen area at the origin of SMA(SSMAFL)and the true lumen stenosis rate both decreased(both P＜0.05);in the collapsed true lumen group,the proportion of aortic true lumen area and minimum SMA true lumen diameter increased(all P＜0.05),whereas SSMAFL and true lumen stenosis rate decreased(all P＜0.05).No reintervention related to intestinal ischemia secondary to SMA dissection was observed during follow-up in all three groups.Conclusion TEVAR or TEVAR combined with endovascular SMA reconstruction is an effective therapeutic option for acute Stanford type B aortic dissection extending into the SMA.For patients with occluded or severely stenosed SMA true lumen caused by dissection,emergency TEVAR combined with SMA stenting is mostly required to improve intestinal blood supply.