Unplanned stents in thoracic endovascular aortic repair for type B aortic dissection: A 16-year single-center report
Unplanned stents in thoracic endovascular aortic repair for type B aortic dissection: A 16-year single-center report
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胸主动脉腔内修复术治疗 B 型主动脉夹层中的计划外支架：16 年单中心报告
DOI：
10.1177/1708538117746555
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发表时间：
2018-08
期刊：
影响因子：
1.1
通讯作者：
Yiming Li
中科院分区：
文献类型：
--
作者：
Zaiping Jing;Junjun Liu;Rongjie Zhang;Rui Feng;Jian Zhou;Jiaxuan Feng;Zhiqing Zhao;Yuxi Zhao;Yiming Li
背景胸主动脉腔内修复术中的非计划支架是指在术前计划之外额外植入支架以达到手术成功。本研究旨在揭示胸主动脉腔内修复术治疗B型主动脉夹层中非计划性支架植入的发生率和后果，探讨非计划性支架植入的原因、风险因素和解决方案。方法回顾性分析1998年9月至2014年6月在我中心行胸主动脉腔内修复术的B型主动脉夹层患者的临床资料。结果符合入选标准的患者共322例，其中计划外组83例（25.8%）。每年胸主动脉腔内修复术治疗B型主动脉夹层的非计划支架发生率呈双峰曲线。曲线显示，2003年和2004年是第一个高峰，也是最高峰，2007年是第二个高峰。计划和非计划患者的5年生存率无差异（对数秩检验，p = 0.994）。计划外组住院费用较高（142，699.08 ± 78，446.75元vs. 175，238.58 ± 34，838.01元; p = 0.019），手术时间较长（104.50 ± 93.24分钟对179.08 ± 142.47分钟; p < 0.001）和住院时间（17.07 ± 16.62天对24.00 ± 15.34天; p = 0.001）。非计划性支架植入的原因为Ia型内漏（46例患者，55.4%）、鸟嘴（25例患者，30.1%）和支架成形不当（9例患者，10.8%）。无症状性主动脉夹层患者的非计划性支架植入率较高。近端瘤颈长度较短（2.66 ± 0.59 mm vs. 2.50 ± 0.51 mm; p = 0.016），短支架覆盖长度（154.62 ± 41.12 mm vs. 133.60 ± 44.33 mm; p = 0.002）和大型远端支架尺寸过大（75.44±10.77% vs. 82.68±15.80%; p <0.001）是胸主动脉腔内修复术中计划外支架的风险因素。结论胸主动脉腔内修复术治疗B型主动脉夹层中非计划性支架植入有其特殊的危险因素和原因。了解这些，我们可以通过适当的方法减少计划外支架的使用。
Background Unplanned stents in thoracic endovascular aortic repair mean additional stents implantation beyond the preoperative planning to achieve operation success. This study aimed to reveal the prevalence and consequences of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection and explore the reasons, risk factors and solutions for unplanned stents. Methods Retrospectively analysis consecutive patients diagnosed as type B aortic dissection with initial tear originating distal from the left subclavian artery and underwent thoracic endovascular aortic repair from September 1998 to June 2014 in our center. Results Under the criteria, this study enrolled 322 patients, with 83 (25.8%) patients in unplanned group. The incidence rate of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection in each year demonstrates as a bimodal curve. The curve showed that, 2003 and, 2004 was the first and highest peak and 2007 was the second peak. There was no difference in five-year survival rate between planned and unplanned patients (log-rank test, p = 0.994). The unplanned group had higher hospitalization expenses (142,699.08 ± 78,446.75 yuan vs. 175,238.58 ± 34,838.01 yuan; p = 0.019), longer operation time (104.50 ± 93.24 min vs. 179.08 ± 142.47 min; p < 0.001) and hospitalization time (17.07 ± 16.62 d vs. 24.00 ± 15.34 d; p = 0.001). The reasons for unplanned stents were type Ia endoleak (46 patients, 55.4%), bird beak (25 patients, 30.1%), and inappropriate shaping of stent (9 patients, 10.8%). Asymptomatic aortic dissection patients had higher incidence of unplanned stents. Short proximal neck length (2.66 ± 0.59 mm vs. 2.50 ± 0.51 mm; p = 0.016), short stent coverage length (154.62 ± 41.12 mm vs. 133.60 ± 44.33 mm; p = 0.002), and large distal stent oversize (75.44±10.77% vs. 82.68±15.80%; p <0.001) were risk factors for unplanned stents in thoracic endovascular aortic repair. Conclusion There are some special risk factors and reasons for unplanned stents in thoracic endovascular aortic repair for type B aortic dissection. Knowing these can we reduce the utilization of unplanned stents with appropriate methods.
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DOI：
10.1016/j.ejvs.2012.12.003
发表时间：
2013-03-01
影响因子：
5.7
作者：
Mueller-Eschner, M.;Rengier, F.;von Tengg-Kobligk, H.
通讯作者：
von Tengg-Kobligk, H.
影响因子：
4.3
作者：
Fillinger, Mark F.;Greenberg, Roy K.;Chaikof, Elliot L.
通讯作者：
Chaikof, Elliot L.
影响因子：
2.6
作者：
G. Melissano;E. Civilini;L. Bertoglio;D. Logaldo;R. Chiesa
通讯作者：
G. Melissano;E. Civilini;L. Bertoglio;D. Logaldo;R. Chiesa
影响因子：
4.3
作者：
Oberhuber, Alexander;Schabhasian, David;Rasche, Volker
通讯作者：
Rasche, Volker
DOI：
10.1016/s0735-6757(99)90165-1
发表时间：
1999-11
期刊：
The American journal of emergency medicine
影响因子：
--
作者：
S. Rahmatullah;I. Khan;V. Nair;N. Caccavo;B. Vasavada;T. Sacchi
通讯作者：
S. Rahmatullah;I. Khan;V. Nair;N. Caccavo;B. Vasavada;T. Sacchi