发生率,预测因素和二次大动脉干预后的影响胸腔内血管大动脉修复为B型剖析的发生率,预测因素和影响
Jizhong Wang1,2, Xiaolu Hu1,2, Jie Liu3
1School of Medicine, South China University of Technology, Guangzhou, China.
概括
胸内血管大动脉修复 (TEVAR) 后的二次大动脉干预 (SAI) 对于B型大动脉剖析 (TBAD) 是常见的. 需要对慢性结核病治疗的TEVAR进行仔细评估,对近位问题进行开放式手术,对远位问题进行内血管治疗.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 大动脉疾病管理管理
背景情况:
- 在胸内血管大动脉修复 (TEVAR) 后,对于B型大动脉剖析 (TBAD) 经常需要二次大动脉干预 (SAI).
- 对于这些患者来说,仍然缺乏确立的管理协议.
- 这项研究报告了一项单一中心的经验,该中心的SAI是在TEVAR治疗TBAD后进行的.
研究的目的:
- 分析B型大动脉剖析 (TBAD) 胸内血管大动脉修复 (TEVAR) 后的二次大动脉干预 (SAI) 的发生率,征兆和结果.
- 为了确定与TEVAR治疗的TBAD患者的SAI和长期预后的风险因素.
主要方法:
- 对860名TBAD患者进行了回顾性审查,这些患者在2010年1月至2017年5月期间接受了TEVAR治疗.
- 对需要SAI的107名患者 (12.4%) 的分析,对指示和干预类型进行分类 (内血管 vs 开放式手术).
- 卡普兰-梅尔生存分析和考克斯比例危险建模,以评估没有SAI和预后因素.
主要成果:
- 在SAI后的30天死亡率为4.7%,内血管和开放手术之间没有显著差异.
- 在没有SAI的患者中,5年累积存活率为92.2%,SAI患者为82.0% (p<0.001).
- 在慢性阶段的TEVAR (27.8%),最大的大动脉直径和门参与是SAI发病率的显著预测因素.
结论:
- 慢性结核病治疗的TEVAR需要仔细考虑;对于近端进展,开放式手术是首选的,而内血管治疗适合远端病变.
- 密切的监测和及时的重新干预对于管理TEVAR后的TBAD患者至关重要.
- 大动脉最大直径是TEVAR治疗TBAD后预后的唯一独立风险因素.
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