Clinical features and outcomes after endovascular therapy for penetrating aortic ulcer and intramural hematoma
Clinical features and outcomes after endovascular therapy for penetrating aortic ulcer and intramural hematoma
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穿透性主动脉溃疡和壁内血肿血管内治疗后的临床特征和结果
DOI：
10.1177/17085381211012573
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发表时间：
2021-04-28
期刊：
影响因子：
1.1
通讯作者：
Dong, Zhihui
中科院分区：
文献类型：
--
作者：
Jiang, Xiaolang;Liu, Yifan;Dong, Zhihui
目的探讨穿透性主动脉溃疡（PAU）和壁内血肿（IMH）血管内治疗后临床特征和结局的差异。方法从2009年1月至2020年3月，入选接受PAU和IMH血管内治疗的患者。收集并分析了患者人口统计学、临床表现、PAU和IMH形态学、实验室检查和临床随访信息。进行单因素分析，以确定IMH和PAU之间的差异，Kaplan-Meier被用来计算累积生存率和自由reintervention.ResultsA共114例患者入组，其中80（70.2%）被诊断为PAU。与PAU相比，IMH患者更年轻（p = 0.006），更可能急诊入院（p = 0.001），住院时间更长（p = 0.028），C反应蛋白水平更高（p = 0.030）。同时，IMH患者更可能与高血压（p = 0.020）和胸腔积液（p < 0.001）相关，并且不太可能有急性冠状动脉综合征（p = 0.019）和既往心血管介入治疗（p = 0.017）病史。5年无再介入率和累积生存率为94.2%（95%置信区间，88.9%-99.9%）和87.8%（95%置信区间，79.5%-96.9%），PAU患者为89.6%，IMH组的阳性率为75.8%~ 99.9%（95%可信区间为68.0%~ 99.9%）;无再干预（p = 0.795）或累积生存率（p = 0.817）无显着差异。结论IMH似乎发生在年轻的高血压患者，通常有一个急性发作，而PAU是更有可能偶然发现在老年患者动脉粥样硬化。血管内治疗在IMH和PAU患者中均有效，结局令人鼓舞。
ObjectivesTo identify the differences between clinical features and outcomes after endovascular therapy for penetrating aortic ulcer (PAU) and intramural hematoma (IMH).MethodsFrom January 2009 to March 2020, patients who underwent endovascular therapy for PAU and IMH were enrolled. Information on patient demographics, presentation, PAU and IMH morphology, laboratory examination, and clinical follow-up information was collected and analyzed. Univariate analysis was performed to identify the differences between IMH and PAU, and Kaplan-Meier was used to calculate the cumulative survival rate and freedom from reintervention.ResultsA total of 114 patients were enrolled; 80 (70.2%) of them were diagnosed with PAU. Compared with PAU, patients with IMH were younger (p = 0.006), more likely to be admitted emergently (p = 0.001), had longer hospital stay (p = 0.028), and had higher levels of C-reactive protein (p = 0.030). Meanwhile, patients with IMH were more likely to be associated with hypertension (p = 0.020) and pleural effusion (p < 0.001) and less likely to have a history of acute coronary syndrome (p = 0.019) and prior cardiovascular intervention (p = 0.017). The five-year freedom from reintervention and cumulative survival rate were 94.2% (95% confidential interval, 88.9%-99.9%) and 87.8% (95% confidential interval, 79.5%-96.9%) in PAU patients and 89.6% (95% confidential interval, 75.8%-99.9%) and 85.1% (95% confidential interval, 68.0%-99.9%) in IMH patients, respectively. There was no significant difference in freedom from reintervention (p = 0.795) or cumulative survival rate (p = 0.817).ConclusionsIMH appeared to occur in younger patients with hypertension and usually had an acute onset, while PAU was more likely to be found incidentally in older patients with atherosclerosis. Endovascular therapy was effective in both IMH and PAU patients with encouraging outcomes.