Hellgren Tina, Wanhainen Anders, Steuer Johnny, Mani Kevin
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Sunderby Hospital, Luleå, Sweden.
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
J Vasc Surg. 2017 Jul;66(1):21-28. doi: 10.1016/j.jvs.2016.12.101. Epub 2017 Feb 16.
The objective of this study was to assess long-term outcome after thoracic endovascular aortic repair (TEVAR) for thoracic aortic aneurysm (TAA).
All patients who underwent TEVAR for TAA at Uppsala University Hospital from December 1999 to December 2014 were included. Characteristics of the patients and outcome data were collected from medical records, national population registry, and cause of death registry. Perioperative survival was analyzed with the χ test, and 5-year survival was estimated with Kaplan-Meier analysis. Predictors of long-term survival were assessed with Cox regression.
There were 77 patients included in the study, 49 with intact TAAs (iTAAs) and 28 with ruptured TAAs (rTAAs). Mean follow-up was 83.7 months for iTAA patients and 82.0 months for rTAA patients (P = .853). Mean age was 71.5 years for iTAA patients and 74.8 years for rTAA patients (P = .04). Survival after iTAA repair was 95.9% at 30 days, 91.8% at 90 days, and 62.5% at 5 years. After rTAA repair, survival was 71.4% at 30 days and decreased to 57.1% at 90 days (P < .01), with most deaths after 30 days being related to the aortic event. The 3-year survival rate after rTAA repair was 27.8%, and only one rTAA patient with 5 years of follow-up remained alive. Six aorta-related deaths occurred after 90 days (three iTAA patients, three rTAA patients); five were due to rupture of nontreated aortic segments. The 5-year reintervention rate was 13.2% for iTAA patients and 17.9% for rTAA patients (P = .682). All reinterventions occurred within 14 months of TEVAR. The age-adjusted hazard ratio for long-term mortality was 4.4 after rTAA repair compared with iTAA repair.
TEVAR for iTAA was associated with low perioperative mortality and acceptable 5-year survival at 62.5%. Results were more pessimistic after rTAA repair, however, for which two-thirds of the patients were deceased at 3-year follow-up. Improved selection of patients is necessary to identify patients who are likely to truly benefit from rTAA repair.
本研究的目的是评估胸主动脉瘤（TAA）腔内修复术（TEVAR）后的长期疗效。
纳入1999年12月至2014年12月在乌普萨拉大学医院接受TAA的TEVAR治疗的所有患者。从医疗记录、国家人口登记处和死亡原因登记处收集患者的特征和疗效数据。采用χ检验分析围手术期生存率，采用Kaplan-Meier分析估计5年生存率。采用Cox回归评估长期生存的预测因素。
本研究共纳入77例患者，其中49例为完整胸主动脉瘤（iTAA），28例为破裂胸主动脉瘤（rTAA）。iTAA患者的平均随访时间为83.7个月，rTAA患者为82.0个月（P = 0.853）。iTAA患者的平均年龄为71.5岁，rTAA患者为74.8岁（P = 0.04）。iTAA修复术后30天生存率为95.9%，90天为91.8%，5年为62.5%。rTAA修复术后，30天生存率为71.4%，90天降至57.1%（P < 0.01），30天后大多数死亡与主动脉事件相关。rTAA修复术后3年生存率为27.8%，仅1例rTAA患者随访5年仍存活。90天后发生6例与主动脉相关的死亡（3例iTAA患者，3例rTAA患者）；5例死于未治疗的主动脉段破裂。iTAA患者的5年再次干预率为13.2%，rTAA患者为17.9%（P = 0.682）。所有再次干预均发生在TEVAR后14个月内。与iTAA修复相比，rTAA修复术后长期死亡的年龄调整风险比为4.4。
iTAA的TEVAR围手术期死亡率低，5年生存率为62.5%，可以接受。然而，rTAA修复后的结果更悲观，在3年随访时三分之二的患者死亡。有必要改进患者选择，以识别可能真正从rTAA修复中获益的患者。
