Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair
Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair
复制标题
胸主动脉腔内修复术后逆行A型夹层和覆膜支架引起的新入口的发生率和危险因素
DOI：
10.1016/j.jvs.2017.08.070
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发表时间：
2018-04-01
影响因子：
4.3
通讯作者：
Xu, Xiao Yun
中科院分区：
文献类型：
--
作者：
Ma, Tao;Dong, Zhi Hui;Xu, Xiao Yun
目的：支架移植物（SG）引起的新进入（SINE）和逆行 A 型夹层（RTAD）是斯坦福 B 型主动脉夹层（TBAD）胸主动脉腔内修复术（TEVAR）后发生的严重的器械相关并发症，可能导致内移植物相关并发症，包括逆行夹层和死亡。本研究的目的是调查 TEVAR 治疗 TBAD 后发生 RTAD 和 SINE 的发生率和危险因素，并确定与之相关的并发症。方法：2005 年 4 月至 2013 年 10 月，有 997 例患者接受 TEVAR 治疗 TBAD； 852 例患者接受了随访（0-6 年；平均 2.6 年），其中 53 名患者出现了 59 例 SINE。比较近端裸支架（PBS）组和非 PBS 组以及 RTAD 和 SINE 组和非 RTAD 和非 SINE 组之间 RTAD 和 SINE 的尺寸过大比例和发生率。分析了可能影响RTAD和远端SINE的基线特征和SG构型因素。结果：PBS组和非PBS组的RTAD发生率没有显着差异。较大的超大尺寸比率与较高的远端 SINE 速率相关。 SINE 在吸烟者以及患有高血压、马凡综合征和慢性期 TEVAR 的患者中更为常见，而在复杂的夹层病例中则较少见。 SINE 的设备相关因素是带连接杆的 SG 和 SG 长度
Objective: Stent graft (SG)-induced new entry (SINE) and retrograde type A dissection (RTAD) are serious device-related complications occurring after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) and may lead to endograft-related complications including retrograde dissection and death. The purpose of this study was to investigate the incidence and risk factors for the development of RTAD and SINE after TEVAR for TBAD and to identify the complications associated with this.Methods: From April 2005 to October 2013, there were 997 patients who underwent TEVAR for TBAD; 852 were followed up (0-6 years; mean, 2.6 years), and 59 SINEs developed in 53 patients. The oversizing ratio and incidence of RTAD and SINE were compared between proximal bare stent (PBS) and non-PBS groups and RTAD and SINE and non-RTAD and non-SINE groups. The baseline characteristics and SG configurational factors potentially affecting both RTAD and distal SINE were analyzed.Results: There was no significant difference between PBS and non-PBS groups in the incidence of RTAD. A greater oversizing ratio was related to a higher distal SINE rate. SINE was seen more frequently in smokers and in patients with hypertension, Marfan syndrome, and TEVAR in the chronic phase and less frequently in complicated dissection cases. Device-related factors for SINE were SG with a connecting bar and SG length