Extended Stent Coverage Decreases Distal Aortic Segmental Enlargement After the Endovascular Repair of Acute Complicated Type B Aortic Dissection: A Multi-Center Retrospective Study of 814 Patients
Extended Stent Coverage Decreases Distal Aortic Segmental Enlargement After the Endovascular Repair of Acute Complicated Type B Aortic Dissection: A Multi-Center Retrospective Study of 814 Patients
复制标题
扩大支架覆盖范围可减少急性复杂 B 型主动脉夹层腔内修复术后远端主动脉段扩大：一项针对 814 名患者的多中心回顾性研究
DOI：
10.1177/15266028211036479
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发表时间：
2021-08-16
影响因子：
2.6
通讯作者：
Liu, MingYuan
中科院分区：
文献类型：
--
作者：
Liu, Junjun;Yan, Chaojun;Liu, MingYuan
目的：本研究旨在探讨胸主动脉腔内修复术治疗复杂B型主动脉夹层（cTBAD）后主动脉远端节段性扩大（DASE）的作用。材料和方法：从2003年3月至2018年10月，回顾性确定了来自5个医疗中心的814例急性cTBAD患者。DASE指的是与最近一次术后计算机断层扫描血管造影（CTA）扫描相比，远端主动脉节段体积增大≥术前体积的1.6倍。在这些患者中，635例（78%）被确定为非DASE，179例（22%）被确定为DASE。进行竞争风险分析，以比较两组之间的晚期死亡和远端主动脉再介入。根据术前CTA和最近CTA测量7个主动脉节段的形态学变量和假腔血栓形成。单因素和多因素考克斯回归分析用于评估DASE的独立预测因素。结果：整个队列的平均随访时间为5.6年（四分位距：2.4-8.3年）。共有208例晚期死亡，包括非DASE组94例（14.8%）死亡和DASE组114例（63.7%）死亡。在89例患者中观察到远端主动脉再介入，其中非DASE组43例（6.7%），DASE组46例（25.7%）。DASE组晚期死亡和远端主动脉再介入的累积发生率显著高于非DASE组（p
Purpose: This study aimed to investigate the effect of distal aortic segmental enlargement (DASE) after thoracic endovascular aortic repair for complicated type B aortic dissection (cTBAD). Materials and Methods: From March 2003 to October 2018, 814 patients with acute cTBAD from 5 medical centers were retrospectively identified. DASE is indicated as the enlargement of distal aortic segmental volume >= 1.6 fold of the preoperative volume compared with the most recent postoperative computed tomography angiography (CTA) scan. Of these patients, 635 (78%) were identified as non-DASE, and 179 (22%) were identified as DASE. Competing risk analysis was performed to compare late death and distal aortic reintervention between the groups. The morphological variables and false lumen thrombosis at 7 aortic levels were measured based on the preoperative CTA and the most recent CTA. Univariate and multivariate Cox regression analyses were used to assess the independent predictors of DASE. Results: The mean follow-up time of the entire cohort was 5.6 years (interquartile range: 2.4-8.3 years). There were total of 208 late deaths, including 94 (14.8%) deaths in non-DASE group versus 114 (63.7%) deaths in the DASE group. Distal aortic reintervention was observed in 89 patients, with 43(6.7%) in the non-DASE group versus 46 (25.7%) in the DASE group. The cumulative incidence of late death and distal aortic reintervention were significantly higher in the DASE than in the non-DASE group (p