Multibranched endovascular aortic aneurysm repair in patients with and without chronic aortic dissections.
Multibranched endovascular aortic aneurysm repair in patients with and without chronic aortic dissections.
复制标题
有或没有慢性主动脉夹层患者的多分支血管内主动脉瘤修复。
DOI：
10.1016/j.jvs.2019.02.048
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发表时间：
2019
影响因子：
4.3
通讯作者：
Hiramoto,JadeS
中科院分区：
文献类型：
--
作者：
Werlin,EvanC;Kaushik,Smita;Gasper,WarrenJ;Hoffman,Megan;Reilly,LindaM;Chuter,TimothyA;Hiramoto,JadeS
本研究的目的是比较夹层后胸腹主动脉瘤（TAAA）和肾旁主动脉瘤（PRAA）的多分支动脉瘤腔内修复术（MBEVAR）与退行性TAAA和PRAA的MBEVAR，并评估术前纠正潜在并发症因素（如重要分支的真腔压缩和假腔起源）所发挥的作用，方法从2005年7月至2017年7月，有162例患者接受了TAAA和PRAAs的选择性MBEVAR。人口统计学数据，程序的细节，和结果prospectively.ResultsThe平均年龄为73 ± 8岁，119 162（74%）是男性，19 162（12%）有主动脉夹层。与未发生夹层的患者相比，发生夹层的患者更年轻（65 ± 11岁vs 74 ± 7岁;P= 0.002），吸烟（13/19 [68%] vs 135/143 [94%];P= 0.002）或外周动脉疾病（0/19 [0%] vs 35/143 [24%];P= 0.01）的可能性更低。有夹层病史的患者更可能患有Crawford II型（10/19 [53%] vs 22/143 [15%];P= .001）和III型（6/19 [32%] vs 16/143 [11%];P= .03）TAAA并且更有可能需要至少一次MBEVAR前辅助手术（14/19 [74%] vs 55/143 [38%];P= 0.006）。两组之间的围手术期死亡、卒中或截瘫发生率无差异。中位随访时间为2.4年（四分位距，0.8-4.7），两组之间无显著差异。两组之间的分支血管闭塞，内漏率，或动脉瘤相关的死亡率没有显着差异。结论慢性B型主动脉夹层患者更有可能有广泛的动脉瘤，更有可能需要进行手术，以提供适当的解剖基板MBEVAR，但这似乎并不影响MBEVAR或其结果的行为。
ObjectiveThe objective of this study was to compare multibranched endovascular aneurysm repair (MBEVAR) of postdissection thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs) with MBEVAR of degenerative TAAAs and PRAAs and to assess the role played by the preoperative correction of potential complicating factors, such as true lumen compression and false lumen origin of vital branches, using adjunctive maneuvers.MethodsFrom July 2005 to July 2017, there were 162 patients who underwent elective MBEVAR of TAAAs and PRAAs. Data on demographics, procedural details, and outcomes were collected prospectively.ResultsThe mean age was 73 ± 8 years, and 119 of 162 (74%) were men; 19 of 162 (12%) had prior aortic dissections. Patients with dissections were younger (65 ± 11 years vs 74 ± 7 years;P= .002) and were less likely to have smoked (13/19 [68%] vs 135/143 [94%];P= .002) or to have peripheral artery disease (0/19 [0%] vs 35/143 [24%];P= .01) compared with those without dissections. Patients with prior dissections were more likely to have Crawford type II (10/19 [53%] vs 22/143 [15%];P= .001) and type III (6/19 [32%] vs 16/143 [11%];P= .03) TAAAs and were more likely to require at least one pre-MBEVAR adjunctive procedure (14/19 [74%] vs 55/143 [38%];P= .006) compared with those without dissection. There was no difference in perioperative death, stroke, or paraplegia rates between the two groups. Median follow-up was 2.4 years (interquartile range, 0.8-4.7) and did not differ significantly between the two groups. There were no significant differences in branch vessel occlusion, endoleak rate, or aneurysm-related death between the two groups.ConclusionsPatients with chronic type B aortic dissection are more likely to have extensive aneurysms and more likely to require adjunctive procedures to provide the appropriate anatomic substrate for MBEVAR, but this does not appear to affect the conduct of MBEVAR or its outcomes.
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