Risk factors for distal stent graft-induced new entry following endovascular repair of type B aortic dissection
Risk factors for distal stent graft-induced new entry following endovascular repair of type B aortic dissection
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DOI：
10.3978/j.issn.2072-1439.2015.11.27
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发表时间：
2015-11-01
影响因子：
2.5
通讯作者：
Sun, Li-Zhong
中科院分区：
文献类型：
--
作者：
Li, Qing;Wang, Long-Fei;Sun, Li-Zhong
背景资料：在B型主动脉夹层（TBAD）的胸主动脉腔内修复术（TEVAR）后，越来越多地观察到远端覆膜支架诱导的新进入（DSINE）。我们试图确定的风险因素DSINE后TEVAR在TBAD.Methods患者：2009年1月至2013年1月，我们进行了TEVAR 579例TBAD患者。临床资料进行回顾性分析，单因素和多因素分析，以确定危险因素DSINe.Results：2例（0.3%）死亡后，最初的TEVAR。死亡包括2例（0.3%）脊髓损伤、3例（0.5%）卒中和12例（2.1%）内漏。100%（577/577）完成了临床和影像学随访，平均随访时间为47 ± 16个月。6例患者发生晚期死亡。39例患者（6.7%）在初始TEVAR后平均22 +/- 17个月发生DSINE，其中25例患者通过重新TEVAR进行管理，14例患者通过药物进行管理。在DSINE后33 +/- 18个月，11例接受药物治疗的患者（11/14）和所有接受re-TEVAR治疗的患者（25/25）存活（P=0.048）。5年时无DSINE率为92.7%（95% CI：90.0-94.7%）。使用近端比远端大4-8 mm的锥形覆膜支架，TEVAR在急性期（
Background: Distal stent graft-induced new entry (DSINE) has been increasingly observed following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We seek to identify the risk factors for DSINE following TEVAR in patients with TBAD.Methods: Between January 2009 and January 2013, we performed TEVAR for 579 patients with TBAD. The clinical data were retrospectively analyzed with univariate and multivariate analyses to identify the risk factors for DSINE.Results: Two patients (0.3%) died after the initial TEVAR. Morbidity included spinal cord injury in 2 (0.3%), stroke in 3 (0.5%) and endoleak in 12 (2.1%) patients. Clinical and radiological follow-up was complete in 100% (577/577) averaging 47 +/- 16 months. Late death occurred in 6 patients. DSINE occurred in 39 patients (6.7%) at mean 22 +/- 17 months after the initial TEVAR, which was managed with re-TEVAR in 25 and medically in 14. At 33 +/- 18 months after DSINE, 11 of patients managed medically (11/14) and all patients managed with re-TEVAR (25/25) survived (P=0.048). Freedom from DSINE was 92.7% at 5 years (95% CI: 90.0-94.7%). Using tapered stent grafts with a proximal end 4-8 mm larger than the distal end, TEVAR performed in the acute phase (