Reintervention after thoracic endovascular aortic repair of complicated aortic dissection
Reintervention after thoracic endovascular aortic repair of complicated aortic dissection
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DOI：
10.1016/j.jvs.2013.08.089
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发表时间：
2014-02-01
影响因子：
4.3
通讯作者：
Alric, Pierre
中科院分区：
文献类型：
--
作者：
Faure, Elsa M.;Canaud, Ludovic;Alric, Pierre
目的：本研究评估了胸主动脉腔内修复术（TEVAR）治疗复杂性主动脉夹层（C-AD）后再次介入的预测因素。Methods：A institutional review of consecutive TEVAR for C-AD was performed.Results：在2000年至2011年期间，41例患者接受了TEVAR治疗涉及胸降主动脉的C-AD。主要适应症包括动脉瘤>55 mm 24例，快速动脉瘤样扩大或即将破裂6例，囊状动脉瘤>20 mm 1例，灌注不良1例，顽固性胸痛3例，破裂6例。技术成功率为100%。30天死亡率为5%（n = 2）。13例患者（32%）因以下适应症进行了14次二次手术：2例器械移位，5例近端I型内漏，2例远端I型内漏，1例II型内漏，2例降胸主动脉瘤样进展，1例夹层腹主动脉瘤样扩张，1例逆行夹层。多变量分析表明，尺寸过大≥ 20%（比值比[ OR]，16; P = 0.011）、覆膜支架近端锚定区的裸弹簧支架（OR，12; P = 0.032）和抗凝治疗（OR，78; P = 0.03）是再次介入的重要因素。在单变量分析中，大动脉瘤是再次介入的危险因素（P = 0.002），而覆膜支架水平的完全假腔血栓形成具有保护作用（P <0.05）。结论：本研究证实了TEVAR治疗C-AD的可行性，尽管再次介入率较高。尺寸过大、近端锚定区的裸弹簧覆膜支架、主动脉大面积扩张和抗凝治疗是再次介入的相关因素。覆膜支架水平的完全假腔血栓形成具有保护作用。
Objective: This study assessed predictive factors for reintervention after thoracic endovascular aortic repair (TEVAR) for complicated aortic dissection (C-AD).Methods: An institutional review of consecutive TEVAR for C-AD was performed.Results: Between 2000 and 2011, 41 patients underwent TEVAR for a C-AD involving the descending thoracic aorta. Primary indications included aneurysm >55 mm in 24, rapid aneurysmal enlargement or impending rupture in 6, saccular aneurysm >20 mm in 1, malperfusion in 1, intractable chest pain in 3, and rupture in 6. Technical success was achieved in 100%. The 30-day mortality rate was 5% (n = 2). Fourteen secondary procedures were performed in 13 patients (32%) for indications of device migration in 2, proximal type I endoleak in 5, distal type I endoleak in 2, type II endoleak in 1, aneurysmal evolution of the descending thoracic aorta in 2, aneurysmal expansion of the dissected abdominal aorta in 1, and retrograde dissection in 1. Multivariate analysis demonstrated that oversizing >= 20% (odds ratio [ OR], 16; P = .011), bare-spring stent in the proximal landing zone of the stent graft (OR, 12; P = .032), and anticoagulant therapy (OR, 78; P = .03) were significant factors for reintervention. On univariate analysis, large aneurysm was a risk factor for reintervention (P = .002), whereas complete false lumen thrombosis at the stent graft level was protective (P < .05).Conclusions: This study confirms the feasibility of TEVAR for C-AD, although the rate of reintervention is high. Excessive oversizing, a bare-spring stent graft in the proximal landing zone, large aortic dilatation, and anticoagulant therapy were factors associated with reintervention. Complete false lumen thrombosis at the stent graft level was protective.