TEVAR 治疗 B 型主动脉夹层假腔血栓形成的预测因素。
Predictors of false lumen thrombosis in type B aortic dissection treated with TEVAR.
机构信息
1 Department of Surgery, University of Virginia, Charlottesville, VA, USA ; 2 Thoracic Aorta Research Center, Policlinico San Donato IRCCS, Milan, Italy ; 3 Department of Surgery, Maasstad ziekenhuis, Rotterdam, The Netherlands.
出版信息
Ann Cardiothorac Surg. 2014 May;3(3):255-63. doi: 10.3978/j.issn.2225-319X.2014.05.17.
BACKGROUND
Thoracic endovascular aortic repair (TEVAR) offers a less invasive treatment option in type B aortic dissection (TBAD) patients and its value has been demonstrated in acute and chronic dissection patients. Total false lumen thrombosis (FLT) is associated with better long-term outcome in these patients, however, this is not obtained in all patients. The purpose of this study was to investigate predictors of FLT.
METHODS
We retrospectively investigated patients who underwent TEVAR for a type B dissection in a large referral center between 2005 and 2012. All patients with a CT angiogram (CTA) obtained preoperatively, postoperatively and after one year of follow-up were selected for analysis. Volume measurements and several morphologic characteristics were analyzed for all scans using Aquarius iNtuition software (TeraRecon, San Mateo, Calif, USA). Multivariate logistic regression analyses were used to study the influence of these characteristics on FLT.
RESULTS
Of 132 patients that received TEVAR for an aortic dissection, 43 patients (mean age, 60.3±14.2; 30 male) met our inclusion criteria, of whom 16 (37%) developed full FLT after 1 yr of follow-up. Multivariate logistic regression showed that side branch involvement [odds ratio (OR), 0.03; 95% confidence interval (CI), 0.00-0.92; P=0.045] and a total patent false lumen (FL) at presentation (OR, 0.01; 95% CI, 0.00-0.58; P=0.027) were associated with decreased complete FLT. Volumetric data showed significantly more reduction of the thoracic false lumen in FLT patients compared with non-FLT (-52.3% vs. -32.4%; P=0.043) and also a tendency of less volume increase in the abdominal segment (-5.0±37.5 vs. 21.8±44.3; P=0.052).
CONCLUSIONS
Patients admitted with type B dissection and branch vessel involvement or a patent entry tear after TEVAR are less likely to develop FLT and aortic remodeling during follow-up. These findings suggest that these patients may require a more extensive procedure and more intensive follow-up to prevent long-term complications.
背景
胸主动脉腔内修复术（TEVAR）为 B 型主动脉夹层（TBAD）患者提供了一种侵入性较小的治疗选择，其在急性和慢性夹层患者中的价值已得到证实。在这些患者中，完全假腔血栓形成（FLT）与更好的长期预后相关，但并非所有患者都能获得。本研究旨在探讨 FLT 的预测因素。
方法
我们回顾性调查了 2005 年至 2012 年期间在一家大型转诊中心接受 TEVAR 治疗的 B 型夹层患者。所有患者均在术前、术后和随访 1 年后获得 CT 血管造影（CTA），选择这些患者进行分析。使用 Aquarius iNtuition 软件（TeraRecon，加利福尼亚州圣马特奥）对所有扫描进行容积测量和多种形态特征分析。使用多变量逻辑回归分析研究这些特征对 FLT 的影响。
结果
在接受 TEVAR 治疗的 132 例主动脉夹层患者中，43 例（平均年龄 60.3±14.2 岁；30 例男性）符合纳入标准，其中 16 例（37%）在随访 1 年后完全形成 FLT。多变量逻辑回归显示，分支血管受累（比值比[OR]，0.03；95%置信区间[CI]，0.00-0.92；P=0.045）和初始完全开放的假腔（OR，0.01；95%CI，0.00-0.58；P=0.027）与完全 FLT 减少相关。容积数据显示，FLT 患者的胸段假腔明显减少（-52.3% vs. -32.4%；P=0.043），腹段假腔的容积增加也有减少的趋势（-5.0±37.5 vs. 21.8±44.3；P=0.052）。
结论
接受 TEVAR 治疗的 B 型夹层患者和分支血管受累或初始入口撕裂的患者在随访过程中不太可能形成 FLT 和主动脉重塑。这些发现表明，这些患者可能需要更广泛的手术和更密切的随访，以防止长期并发症。
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