St George's Vascular Institute NHS Trust, University of London, London, UK.
Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Universitaire (CHU) de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM) U1008, University of Lille, Lille, France.
Br J Surg. 2016 Jun;103(7):819-29. doi: 10.1002/bjs.10138. Epub 2016 Apr 20.
The fate of the aneurysm sac after thoracic endovascular aortic repair (TEVAR) remains poorly defined. The aim of this study was to characterize the incidence of aneurysm sac expansion after TEVAR, and to determine the effect of aneurysm morphology on postoperative sac behaviour.
Preoperative and postoperative CT angiography (CTA) images were analysed from a proprietary database (M2S). TEVARs undertaken for thoracic aortic aneurysms from 2004 to 2013 were included. Preoperative aortic morphology was available for each patient. Post-TEVAR sac expansion was defined as an increase in aortic diameter of at least 5 mm. The influence of aortic morphological variables on sac expansion was assessed using Cox regression and Kaplan-Meier analysis.
CTA images were available for 899 patients who underwent TEVAR. Median follow-up was 2·1 (i.q.r. 1·7-2·4) years. Some 46·0 per cent had a maximum aneurysm diameter of 55 mm or more at the time of repair. The 5-year rate of freedom from sac expansion of at least 5 mm was 60·9 per cent. The sac expansion rate after 3 years was higher when the proximal sealing zone was over 38 mm in diameter (freedom from expansion 51·2 per cent versus 76·6 per cent for diameter 38 mm or less; P < 0·001), or 20 mm or less in length (freedom from expansion 67·3 per cent versus 77·1 per cent for length exceeding 20 mm; P = 0·022). Findings for the distal sealing zone were similar. The risk of sac expansion increased according to the number of adverse morphological risk factors (freedom from expansion rate 79·1 per cent at 3 years in patients with 2 or fewer risk factors versus 45·7 per cent in those with more than 2; P < 0·001).
Sac expansion was common in this cohort of patients undergoing TEVAR for thoracic aortic aneurysm. Aneurysm sac expansion was significantly influenced by adverse morphological features in the aortic stent-graft sealing zones.
胸主动脉腔内修复术（TEVAR）后动脉瘤囊的命运仍未得到明确界定。本研究旨在描述 TEVAR 后动脉瘤囊扩张的发生率，并确定动脉瘤形态对术后囊状行为的影响。
从专有数据库（M2S）中分析了 2004 年至 2013 年间进行的胸主动脉瘤 TEVAR 的术前和术后 CT 血管造影（CTA）图像。每位患者均提供了术前主动脉形态学资料。TEVAR 后动脉瘤囊扩张定义为主动脉直径至少增加 5mm。采用 Cox 回归和 Kaplan-Meier 分析评估主动脉形态学变量对囊扩张的影响。
899 例接受 TEVAR 的患者有 CTA 图像。中位随访时间为 2.1（IQR 1.7-2.4）年。在修复时，46.0%的患者最大动脉瘤直径为 55mm 或更大。5 年无至少 5mm 囊扩张的生存率为 60.9%。3 年后，近端密封区直径大于 38mm（无扩张率为 51.2%，直径小于 38mm 为 76.6%；P<0.001）或长度为 20mm 或更短时（无扩张率为 67.3%，长度超过 20mm 为 77.1%；P=0.022），囊扩张率较高。远端密封区的发现相似。根据不良形态学危险因素的数量，囊扩张的风险增加（3 年内有 2 个或更少危险因素的患者无扩张率为 79.1%，有超过 2 个危险因素的患者为 45.7%；P<0.001）。
在本队列中，接受 TEVAR 治疗的胸主动脉瘤患者中，囊扩张很常见。动脉瘤囊扩张与主动脉支架移植物密封区的不良形态特征显著相关。
