Severe intraluminal atheroma and iliac artery access affect spinal cord ischemia after thoracic endovascular aortic repair for degenerative descending aortic aneurysm
Severe intraluminal atheroma and iliac artery access affect spinal cord ischemia after thoracic endovascular aortic repair for degenerative descending aortic aneurysm
复制标题
退行性降主动脉瘤胸主动脉腔内修复术后严重管腔内粥样斑块和髂动脉通路影响脊髓缺血
DOI：
10.1007/s11748-021-01593-6
复制
发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Matsuda H.
中科院分区：
文献类型：
--
作者：
Seike Y;Fukuda T;Yokawa K;Horinouchi H;Inoue Y;Shijo T;Uehara K;Sasaki H;Matsuda H.
目的本研究旨在揭示胸降主动脉瘤（TAA）胸主动脉腔内修复术（TEVAR）后可能导致脊髓缺血（SCI）的多因素发病机制的其他因素。方法收集2011年至2018年间接受TEVAR但未进行脱支手术的293例胸降主动脉瘤患者的医疗记录 进行了回顾性审查。我们从研究中排除了以下病例： 72 名主动脉夹层患者； 15 有破裂； 14 患有吻合口假性动脉瘤； 22 与重新TEVAR； 34 未评估 Adamkiewicz 动脉（AKA）。 136 名患者（79% 为男性；平均年龄为 76±7.4 岁）可获得足够的数据。我们使用逻辑回归分析进行单变量和多变量分析，以评估术前/术中因素与术后 SCI 之间的关系。结果 9 名患者（6.8%）观察到 SCI。通过单变量分析，严重管腔内动脉粥样硬化[比值比 (OR)，6.23；p= 0.014] 和髂动脉通路 (OR 4.65；p= 0.043) 被确定为 SCI 的阳性预测因子。另外确定 SCI 的危险因素如下：肋间动脉分支 AKA 的覆盖范围（ICA-AKA）（OR 4.89；p= 0.054）； ICA-AKA 与髂通路的覆盖范围（OR 10.1；p= 0.002）；合并严重管腔内粥样硬化斑块(OR 13.7;p= 0.001)。结论严重管腔内粥样硬化斑块和髂动脉通路是退行性TAA降段TEVAR术后发生SCI的独立预测因素。对于主动脉髂股入路复杂的患者，ICA-AKA 的覆盖与 SCI 风险相关。
ObjectivesThis study aimed to reveal additional factors potentially contributing to the multifactorial ethiopathogenesis of spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) for descending thoracic aortic aneurysm (TAA).MethodsThe medical records of 293 patients who underwent TEVAR without debranching procedures for descending TAA between 2011 and 2018 were retrospectively reviewed. We excluded the following cases from the study: 72 patients with aortic dissection; 15 with rupture; 14 with anastomotic pseudoaneurysm; 22 with re-TEVAR; 34 without evaluation of the artery of Adamkiewicz (AKA). Sufficient data were available for 136 patients (79% men; mean age of 76 ± 7.4 years). We conducted univariable and multivariable analyzes using the logistic regression analysis to assess the relationship between pre-/intraoperative factors and postoperative SCI.ResultsSCI was observed in nine patients (6.8%). Severe intraluminal atheroma [odds ratio (OR), 6.23;p= 0.014] and iliac artery access (OR 4.65;p= 0.043) were identified as the positive predictors of SCI by univariable analysis. Risk factors of SCI were determined additionally as follows: coverage of the intercostal artery branching AKA (ICA-AKA) (OR 4.89;p= 0.054); coverage of the ICA-AKA combined with iliac access (OR 10.1;p= 0.002); that combined with severe intraluminal atheroma (OR 13.7;p= 0.001).ConclusionSevere intraluminal atheroma and iliac artery access were the independent predicting factors of SCI after TEVAR for degenerative descending TAA. In patients with complicated aortoiliofemoral access route, coverage of the ICA-AKA is associated with the risk of SCI.
登录
查看更多内容
使用戈尔 TAG 装置治疗退行性胸降主动脉瘤的中期结果
影响因子：
1.2
作者：
J. Yunoki;T. Kuratani;Y. Shirakawa;K. Torikai;K. Shimamura;K. Kin;Y. Sawa
通讯作者：
Y. Sawa
影响因子：
2.8
作者：
Nishii, Tatsuya;Kotoku, Akiyuki;Fukuda, Tetsuya
通讯作者：
Fukuda, Tetsuya
DOI：
10.1016/j.jtcvs.2019.07.112
发表时间：
2020-10-01
影响因子：
6
作者：
Yokawa, Koki;Ikeno, Yuki;Okita, Yutaka
通讯作者：
Okita, Yutaka
术中运动诱发电位评估预测胸腹主动脉瘤修复术后截瘫
影响因子：
2.8
作者：
T. Horiuchi;M. Kawaguchi;S. Inoue;Hironobu Hayashi;R. Abé;N. Tabayashi;S. Taniguchi;H. Furuya
通讯作者：
H. Furuya
非夹层胸主动脉病变患者的高风险血管内手术结果：中间结果。
影响因子：
3.4
作者：
B. Rylski;P. Blanke;M. Siepe;F. Kari;W. Euringer;M. Südkamp;F. Beyersdorf
通讯作者：
F. Beyersdorf