Outcome After Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm: A National Multicentre Study
Outcome After Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysm: A National Multicentre Study
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DOI：
10.1016/j.ejvs.2018.10.029
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发表时间：
2019-06-01
影响因子：
5.7
通讯作者：
Wahlgren, Carl-Magnus
中科院分区：
文献类型：
--
作者：
Hammo, Sari;Larzon, Thomas;Wahlgren, Carl-Magnus
目的：本多中心研究的目的是分析胸主动脉腔内修复术(TEVAR)治疗胸降主动脉瘤破裂(RDTAA)的结果。方法：这是一项全国性的回顾性研究，包括2000年1月至2015年12月在瑞典六大血管大学中心接受TEVAR治疗的所有患者。结果：140例rDTAA患者(平均年龄74.1±8.8岁；56%男性；动脉瘤大小64.8±19 mm)。53例(37.9%)左锁骨下动脉被覆盖，25例(17.9%)弓血管重建。总体而言，61/136名患者(45%)在TEVAR术后30天内出现主要并发症。最常见的并发症是中风(n=20，14.7%)，其次是截瘫(n=13，9.6%)和大出血(n=13，9.6%)。术后TEVAR相关并发症发生率为22.1%(30/136，其中1a型14例，1b型6例，未明确10例)。总共有27/137(19.7%)患者需要再次干预(n=31)。中位随访时间为17.0个月(0~132个月)。Kaplan-Meier估计1个月、3个月、1年、3年和5年生存率分别为80.0%、71.7%、65.3%、45.9%和31.9%。年龄(HR 1.03；95%CI 1.00-1.07；p=.046)、中风病史(HR 2.35；95%CI 1.194.63；p=.014)、既往主动脉手术(HR 2.11；95%CI 1.15-3.87；p=.016)以及术后大出血(HR 4.40；95%CI 2.20-8.81；p=.001)、中风(HR 2.63；95%CI 1.37-5.03；P=.004)和肾功能衰竭(HR 8.25；95%CI 2.69-25.35；P=.001)均与死亡率相关。结论：这项对接受TEVAR的rDTAA患者进行的全国性多中心研究显示出可以接受的短期生存，但长期生存较差。足够的近端和远端主动脉密封区对于技术成功是重要的。高危患者和术后并发症需要进一步解决，以努力改善结果。
Objective: The purpose of this multicentre study was to analyse the outcome of thoracic endovascular aortic repair (TEVAR) in patients with ruptured descending thoracic aortic aneurysm (rDTAA).Methods: This is a nationwide retrospective study including all patients who underwent TEVAR for rDTAA at six major vascular university centres in Sweden between January 2000 and December 2015. Outcome measures were analysed using Kaplan-Meier estimator and multivariable Cox regression.Results: There were 140 patients (age [mean +/- SD] 74.1 +/- 8.8 years; 56% men; aneurysm size 64.8 +/- 19 mm), with rDTAA. In 53 patients (37.9%), the left subclavian artery was covered, and in 25 patients (17.9%) arch vessel revascularisation was performed. In total, 61/136 patients (45%) had a major complication within 30 days post TEVAR. Stroke (n = 20; 14.7%) was the most common complication, followed by paraplegia (n = 13; 9.6%) and major bleeding (n = 13; 9.6%). TEVAR related complications during follow up included endoleaks 22.1% (30/136; 14 type 1a, six type 1b, 10 not defined). In total, re-interventions (n = 31) were required in 27/137 (19.7%) patients. The median follow up time was 17.0 months (range 0-132 months). The Kaplan-Meier estimated survival was 80.0% at one month, 71.7% at three months, 65.3% at one year, 45.9% at three years, and 31.9% at five years. Age (HR 1.03; 95% CI 1.00-1.07; p = .046), history of stroke (HR 2.35; 95% CI 1.194.63; p = .014), previous aortic surgery (HR 2.11; 95% CI 1.15-3.87; p = .016) as well as post-operative major bleeding (HR 4.40; 95% CI 2.20-8.81; p = .001), stroke (HR 2.63; 95% CI 1.37-5.03; p = .004), and renal failure (HR 8.25; 95% CI 2.69-25.35; p = .001) were all associated with mortality.Conclusions: This nationwide multicentre study of patients with rDTAA undergoing TEVAR showed acceptable short- but poor long-term survival. Adequate proximal and distal aortic sealing zones are important for technical success. High risk patients and post-operative complications need to be further addressed in an effort to improve outcome.