Results of high-risk endovascular procedures in patients with non-dissected thoracic aortic pathology: intermediate outcomes.
Results of high-risk endovascular procedures in patients with non-dissected thoracic aortic pathology: intermediate outcomes.
复制标题
非夹层胸主动脉病变患者的高风险血管内手术结果：中间结果。
DOI：
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发表时间：
2013
影响因子：
3.4
通讯作者：
F. Beyersdorf
中科院分区：
文献类型：
--
作者：
B. Rylski;P. Blanke;M. Siepe;F. Kari;W. Euringer;M. Südkamp;F. Beyersdorf
目标
研究因非夹层主动脉病变（锚定区和主动脉解剖结构有利和不利）接受胸主动脉腔内修复术（TEVAR）的患者的中期结局。
方法
在2000年至2011年期间，对208例胸降主动脉疾病患者进行了TEVAR。在105例非夹层胸主动脉病变患者中，69例存在不利的解剖结构，定义为长度短（<15 mm）、直径大（>42 mm）、近端或远端锚定区成角>60°或主动脉极度迂曲。将终点围手术期死亡率、1年生存率、内漏发生率和二次干预发生率与其余36例解剖结构良好的患者进行比较。
结果
中位随访时间为18个月。在69例解剖结构不利的患者中有24例（35%）和36例解剖结构有利的患者中有11例（31%）紧急进行了TEVAR（P = 0.68）。无患者转为开放手术，未观察到介入周围破裂。两个队列的围手术期死亡率无差异（1/69 vs 1/36，P = 0.78）。术后永久性脊髓缺血仅发生在解剖结构不利的患者中（2/69 vs 0/36，P = 0.78）。早期内漏和二次介入在解剖结构不利的患者中更常见（19/69 vs 7/36和13/69 vs 1/36），但无统计学显著性（分别为P = 0.5和P = 0.13）。两组患者的1年生存率相似（66/69 vs 33/36，P = 0.45）。
结论
在靶点相关生存率方面，具有有利和不利锚定区解剖结构的患者在TEVAR后的中期结局无差异。然而，更频繁地需要二次干预，这就要求对解剖结构不利的患者进行TEVAR后进行更严格的随访。
OBJECTIVES
To investigate mid-term outcome in patients undergoing thoracic endovascular aortic repair (TEVAR) for non-dissected aortic pathology with favourable and unfavourable landing zone and aortic anatomy.
METHODS
Between 2000 and 2011, TEVAR was performed in 208 patients with descending thoracic aortic disease. Of 105 patients with non-dissected thoracic aortic pathology, 69 presented with unfavourable anatomy as defined by short length (<15 mm), large diameter (>42 mm), angulation of >60° of the proximal or distal landing zone or extreme aortic tortuosity. The endpoints perioperative mortality, 1-year survival, endoleak occurrence and incidence of secondary intervention were compared with the remaining 36 patients with favourable anatomy.
RESULTS
Median follow-up was 18 months. TEVAR was performed emergently in 24 of 69 (35%) patients with unfavourable anatomy and in 11 of 36 (31%) of those with favourable anatomy (P = 0.68). No patients underwent conversion to open surgery, no periinterventional rupture was observed. Perioperative mortality did not differ between cohorts (1/69 vs 1/36, P = 0.78). Postoperative permanent spinal cord ischaemia occurred in patients with unfavourable anatomy only (2/69 vs 0/36, P = 0.78). Early endoleak and secondary intervention were more frequent in patients with unfavourable anatomy (19/69 vs 7/36 and 13/69 vs 1/36), but not statistically significant (P = 0.5 and P = 0.13, respectively). One-year aorta-related survival rates were similar in both groups (66/69 vs 33/36, P = 0.45).
CONCLUSIONS
Mid-term outcome after TEVAR does not differ between patients with favourable and unfavourable landing zone anatomy in terms of aorta-related survival. However, the more frequent need for secondary intervention warrants a more rigorous follow-up after TEVAR in patients with unfavourable anatomy.
影响因子：
120.7
作者：
Clouse, WD;Hallett, JW;Schaff, HV
通讯作者：
Schaff, HV