Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair.
Retrograde ascending aortic dissection as an early complication of thoracic endovascular aortic repair.
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DOI：
10.1016/j.jvs.2011.11.063
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发表时间：
2012-05
影响因子：
4.3
通讯作者：
Hughes, G. Chad
中科院分区：
文献类型：
--
作者：
Williams, Judson B.;Andersen, Nicholas D.;Bhattacharya, Syamal D.;Scheer, Elizabeth;Piccini, Jonathan P.;McCann, Richard L.;Hughes, G. Chad
逆行升主动脉夹层（rAAD）是胸血管内主动脉修复术（TEVAR）的潜在并发症，但有关其发生的资料很少。本研究探讨了该事件的发生率、病因和结果。前瞻性机构数据库用于从2005年3月（FDA首次批准日期）至2010年9月的309例连续手术中确定TEVAR后急性rAAD病例。分析数据库中rAAD的并发症以及相关的患者和手术变量。rAAD的发生率为1.9% (n=6/309)；所有病例均发生在升主动脉和/或弓近端着陆区（0-2区）。所有患者均在围手术期（0-6天）确诊，30天/住院死亡率为33%（2/6）。83%（5/6）接受紧急修复；1例患者未经修复死亡。rAAD患者与非rAAD组（n=303）在相关变量上相似，包括年龄、性别、种族和设备尺寸（均P < 0.1）。动脉瘤的rAAD发病率为1.0%(2/200)，夹层为4.4%(4/91)，横断为0% (0/18)；p = 0.08。设备引起的rAAD发生率为：TAG (Gore) 1.0%, n=2/205；人才（美敦力）4.7%,n=2/43；Zenith TX2 (Cook) 3.6%, n=2/55。升主动脉直径≥4.0 cm的患者rAAD发病率更高（4.8% vs. 0.9%升主动脉直径< 4.0 cm）， p=0.047。原生升主动脉近端着陆区（0区）的发生率也较高，为6.9%(2/29)，其他均为1.4% (4/280),p=0.101。在有夹层病理且升主动脉直径≥4.0 cm的患者中，11%（3/28）发生了rAAD；合并原生升主动脉（0区）着陆区≥4.0 cm发生率为25%（2/8）。最终诊断是通过CTA （n=1）、术中经食管超声心动图（TEE） （n=3）、术中动脉造影（n=1）或尸检（n=1）。rAAD是TEVAR的一种致命的早期并发症，在治疗夹层时更为常见，使用近端裸弹簧或倒刺固定装置，近端着陆区为原生区0，升主动脉直径≥4cm。这些风险因素的组合可能会产生特别高的风险。术中升主动脉影像学评估应在TEVAR后进行，以避免识别不足。需要国家数据库报告这种并发症，以确保新兴TEVAR技术的安全性和正确应用。
Retrograde ascending aortic dissection (rAAD) is a potential complication of thoracic endovascular aortic repair (TEVAR) yet little data exists regarding its occurrence. This study examines the incidence, etiology, and outcome of this event. A prospective institutional database was used to identify cases of acute rAAD following TEVAR from a cohort of 309 consecutive procedures from 3/2005 (date of initial FDA approval) to 9/2010. The database was analyzed for the complication of rAAD as well as relevant patient and operative variables. The incidence of rAAD was 1.9% (n=6/309); all cases occurred with proximal landing zone in the ascending aorta and/or arch (zones 0–2). All were identified in the perioperative period (range 0–6 days) with 33% (2/6) 30 day/in-hospital mortality. 83% (5/6) underwent emergent repair; 1 patient died without repair. rAAD patients were similar to the non-rAAD group (n=303) across pertinent variables including age, sex, race, and device size (all P>0.1). rAAD incidence by aortic pathology was: 1.0% (2/200) for aneurysm, 4.4% (4/91) for dissection, and 0% (0/18) for transection; p=0.08. rAAD incidence by device was: TAG (Gore) 1.0%, n=2/205; Talent (Medtronic) 4.7%, n=2/43; and Zenith TX2 (Cook) 3.6%, n=2/55. rAAD incidence was observed to be higher among patients with an ascending aortic diameter ≥4.0 cm (4.8% vs. 0.9% for ascending diameter < 4.0 cm), p=0.047. Incidence was also higher with proximal landing zone in native ascending aorta (zone 0) 6.9% (2/29) vs. 1.4% for all others (4/280), p=0.101. For patients with dissection pathology and an ascending aortic diameter ≥4.0 cm, 11% (3/28) suffered rAAD; with the combination of native ascending aorta (zone 0) landing zone measuring ≥4.0 cm the incidence was 25% (2/8). Definitive diagnosis was by CTA (n=1), intraoperative transesophageal echocardiography (TEE) (n=3), intraoperative arteriography (n=1), or postmortem autopsy (n=1). rAAD is a lethal early complication of TEVAR, which may be more common when treating dissection, with devices utilizing proximal bare springs or barbs for fixation, with native zone 0 proximal landing zone, and with ascending aortic diameter ≥ 4 cm. Combinations of these risk factors may be particularly high risk. Intraoperative imaging assessment of the ascending aorta should be conducted following TEVAR to avoid under-recognition. National database reporting of this complication is needed to ensure safety and proper application of emerging TEVAR technology.
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影响因子：
4.3
作者：
Chaikof, EL;Blankensteijn, JD;Kent, KC
通讯作者：
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通讯作者：
Hughes, G. Chad
影响因子：
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作者：
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Eagle, KA