脊髓缺血和急性乙型大动脉剖析胸腔内血管修复后的重新干预
Helen A Potter1, Li Ding2, Sukgu M Han3
1Division of Vascular Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
Journal of vascular surgery
|May 9, 2024
概括
在急性B型大动脉剖析的胸内血管大动脉修复中,近端密封区2没有增加重新干预或脊髓缺血,但远端密封区5确实增加了SCI风险. 限制大动脉覆盖面是非常重要的.
科学领域:
- 血管外科 血管外科
- 心血管成像 - 心血管成像
- 干预心脏病学 干预心脏病学
背景情况:
- 胸内血管大动脉修复 (TEVAR) 是急性B型大动脉解剖 (TBAD) 的关键治疗方法.
- 最佳的技术参数,包括近端和远端密封区 (PSZ和DSZ) 的选择,左下关节动脉 (LSA) 管理和预防性腰部排水,仍在争论中.
- 这些技术选择与已知的风险一起带来潜在的好处,需要进一步调查它们对患者结果的影响.
研究的目的:
- 为了确定与重新干预和脊髓缺血 (SCI) 相关的因素,在TEVAR治疗急性TBAD后,带有3区入口撕裂.
- 评估PSZ位置 (区2与区3),DSZ长度 (区4与区5),LSA再血管化和预防性腰部排水使用对关键临床结果的影响.
主要方法:
- 血管质量倡议数据库对急性TBAD中TEVAR程序的回顾性分析,带有3区入口撕裂.
- 包括在2区和5区之间使用TEVAR治疗的患者.
- 主要结局是SCI和重新干预;次要结局包括中风,手臂缺血和逆行型A解剖 (RTAD).
- 使用多变量后勤回归来评估暴露变量 (PSZ,DSZ,腰部排水,LSA再血管) 与结果之间的关联.
主要成果:
- 在583名患者中,266人患有PSZ2,317人患有PSZ3. 在多变量分析中,PSZ 2与重新干预或SCI没有显著关联,但趋向于更高的中风率.
- 在单变量和多变量分析中,DSZ 5 (更长的覆盖范围) 与DSZ 4 (更短的覆盖范围) 相比,与SCI的更高率显著相关 (OR,7.384;P = .001).
- 手术后的LSA通透性缺乏与SCI相关 (OR,2.966;P = .05),而预防性腰部排水装置的放置与SCI没有统计学上显著的关联.
结论:
- 在TEVAR中,对于急性结核病的近接海区域2的覆盖率与增加的再干预或SCI无关,尽管它可能趋向于更高的中风率.
- 广泛的大动脉覆盖 (DSZ 5) 是急性结核病的TEVAR后SCI的显著独立预测因素.
- 这些发现强调了尽可能尽量减少主动脉覆盖到近端入口撕裂区域的重要性,以减少SCI的风险.
相关概念视频
Peripheral Artery Disease III: Interprofessional Care
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...


