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Please use this identifier to cite or link to this item: http://hdl.handle.net/10564/3762

Title: Management of Renal Arteries in Conjunction with Thoracic Endovascular Aortic Repair for Complicated Stanford Type B Aortic Dissection: The Japanese Multicenter Study (J-Predictive Study).
Other Titles: 合併症を有するB型大動脈解離に対するステントグラフト内挿術における腎動脈に対する治療戦略 : 多施設共同研究
Authors: Iwakoshi, Shinichi
Dake, Michael D
Irie, Yoshihito
Katada, Yoshiaki
Sakaguchi, Shoji
Hongo, Norio
Oji, Katsuki
Fukuda, Tetsuya
Matsuda, Hitoshi
Kawasaki, Ryota
Taniguchi, Takanori
Motoki, Manabu
Hagihara, Makiyo
Kurimoto, Yoshihiko
Morikage, Noriyasu
Nishimaki, Hiroshi
Sueyoshi, Eijun
Inoue, Kyozo
Shimizu, Hideyuki
Ideta, Ichiro
Higashigawa, Takatoshi
Ikeda, Osamu
Miyamoto, Naokazu
Nakai, Motoki
Nakai, Takahiro
Ichihashi, Shigeo
Inoue, Takeshi
Inoue, Takashi
Yamaguchi, Masato
Tanaka, Ryoichi
Kichikawa, Kimihiko
Issue Date: Feb-2020
Publisher: Radiological Society of North America
Citation: Radiology Vol.294 No.2 p.455-463 (2020 Feb)
Abstract: Background: Management of abdominal branches associated with Stanford type B aortic dissection is controversial without definite criteria for therapy after thoracic endovascular aortic repair (TEVAR). This is in part due to lack of data on natural history related to branch vessels and their relationship with the dissection flap, true lumen, and false lumen. Purpose: To investigate the natural history of abdominal branches after TEVAR for type B aortic dissection and the relationship between renal artery anatomy and renal volume as a surrogate measure of perfusion. Materials and Methods: This study included patients who underwent TEVAR for complicated type B dissection from January 2012 to March 2017 at 20 centers. Abdominal aortic branches were classified with following features: patency, branch vessel origin, and presence of extension of the aortic dissection into a branch (pattern 1, supplied by the true lumen without branch dissection; pattern 2, supplied by the true lumen with branch dissection, etc). The branch artery patterns before TEVAR were compared with those of the last follow-up CT (mean interval, 19.7 months) for spontaneous healing. Patients with one kidney supplied by pattern 1 and the other kidney by a different pattern were identified, and kidney volumes over the course were compared by using a simple linear regression model. Results: Two hundred nine patients (mean age ± standard deviation, 66 years ± 13; 165 men and 44 women; median follow-up, 18 months) were included. Four hundred fifty-nine abdominal branches at the last follow-up were evaluable. Spontaneous healing of the dissected branch occurred in 63% (64 of 102) of pattern 2 branches. Regarding the other patterns, 6.5% (six of 93) of branches achieved spontaneous healing. In 79 patients, renal volumes decreased in kidneys with pattern 2 branches with more than 50% stenosis and branches supplied by the aortic false lumen (patterns 3 and 4) compared with contralateral kidneys supplied by pattern 1 (pattern 2 vs pattern 1: −16% ± 16 vs 0.10% ± 11, P = .002; patterns 3 and 4 vs pattern 1: −13% ± 14 vs 8.5% ± 14, P = .004). Conclusion: Spontaneous healing occurs more frequently in dissected branches arising from the true lumen than in other branch patterns. Renal artery branches supplied by the aortic false lumen or a persistently dissected artery with greater than 50% stenosis are associated with significantly greater kidney volume loss.
Description: 博士(医学)・乙第1461号・令和2年6月30日
Copyright © 2019 by authors and RSNA. This work is licensed under the Creative Commons Attribution International License (CC BY-NC-ND 4.0). https://creativecommons.org/licenses/by-nc-nd/4.0/.
URI: http://hdl.handle.net/10564/3762
ISSN: 00338419
Academic Degrees and number: 24601B1461
Degree-granting date: 2020-06-30
Degree name: 博士(医学)
Degree-granting institutions: 奈良県立医科大学
Appears in Collections:2020年度

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