Division of Vascular Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc.
Division of Vascular Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisc.
J Vasc Surg. 2014 May;59(5):1241-6. doi: 10.1016/j.jvs.2013.11.075. Epub 2014 Jan 11.
The purpose of this study was to evaluate acute changes in aortic size before and after endograft placement for traumatic injury and aneurysmal disease. We hypothesize that there are inherent differences between trauma and aneurysm populations undergoing thoracic endovascular aortic repair (TEVAR) and that these factors may affect device choice and sizing for each group.
This retrospective study evaluated the existing digital imaging of traumatic injury and aneurysmal patients enrolled in the 0802 and 0803 multi-site trials that received the GORE Conformable TAG thoracic device. Pre- and post-treatment imaging was available for 70 traumatic injury and 54 aneurysmal patients. Post-treatment imaging was defined as being complete within 30 days of treatment. A standardized protocol was used to complete measurements of the proximal and distal maximum neck diameters through the use of the orthogonal view before imaging and at 30-day imaging. The resultant changes in diameter for each group were analyzed by means of t-tests.
Mean increases in proximal (3.0 mm vs 2.0 mm; P < .05) and distal neck diameters (2.9 mm vs 0.7 mm; P < .01) after TEVAR are significantly greater in traumatic injury patients than in aneurysm patients between pretreatment and 30-day imaging. In both study populations, smaller pretreatment aortic neck diameters showed a larger change in neck diameter than did larger pretreatment aortic diameters. Aneurysm patients were oversized significantly more than were trauma patients at the proximal neck (9.1% vs 4.5%; P < .05). However, at the distal neck, the trauma patients were oversized more than were the aneurysm patients (17.5% vs 13.6%; P = .06). A strong correlation was found between the percentage of oversizing and change in the distal neck diameter after TEVAR in both patient groups.
The results suggest that there are differences between trauma and aneurysm populations. Careful device selection may contribute to the avoidance of complications related to both undersized and oversized devices. Short-term analysis shows that TEVAR can be successfully accomplished in both trauma and aneurysm groups over a wide sizing range. Further data regarding long-term device complications are needed to better characterize this relationship.
本研究旨在评估创伤性损伤和动脉瘤性疾病患者行血管内覆膜支架置入术前后主动脉大小的急性变化。我们假设，行胸主动脉腔内修复术（TEVAR）的创伤和动脉瘤患者人群之间存在固有差异，这些因素可能会影响每个群体的器械选择和尺寸。
本回顾性研究评估了接受戈尔顺应性 TAG 胸主动脉器械治疗的 0802 和 0803 多中心试验中纳入的创伤性损伤和动脉瘤患者的现有数字影像学资料。70 例创伤性损伤患者和 54 例动脉瘤患者获得了治疗前后的影像学资料。治疗后影像学资料定义为治疗后 30 天内完成。使用正交视图在术前和 30 天影像学检查时完成近端和远端最大颈部直径的标准化测量。使用 t 检验分析每组的直径变化。
与动脉瘤患者相比，TEVAR 后创伤性损伤患者的近端（3.0 毫米对 2.0 毫米；P<.05）和远端颈部直径（2.9 毫米对 0.7 毫米；P<.01）的平均增加量显著更大。在这两个研究人群中，与较大的术前主动脉颈直径相比，较小的术前主动脉颈直径的颈直径变化更大。与创伤性损伤患者相比，动脉瘤患者在近端颈部明显过大（9.1%比 4.5%；P<.05）。然而，在远端颈部，创伤性损伤患者的过大比例高于动脉瘤患者（17.5%比 13.6%；P=.06）。在这两个患者群体中，TEVAR 后远端颈部直径的过度扩张百分比与变化之间存在很强的相关性。
结果表明，创伤性损伤和动脉瘤患者人群之间存在差异。仔细选择器械可能有助于避免与器械过小和过大相关的并发症。短期分析表明，在广泛的尺寸范围内，TEVAR 可成功应用于创伤性损伤和动脉瘤患者群体。需要进一步的数据来更好地描述这种关系，以了解长期设备并发症。
