Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
J Thorac Cardiovasc Surg. 2018 Jan;155(1):21-29.e3. doi: 10.1016/j.jtcvs.2017.09.010. Epub 2017 Sep 15.
The study objective was to assess the effect of preoperative thoracic false lumen branches on thoracic aortic enlargement along the stent graft after thoracic endovascular aortic repair for DeBakey IIIb aortic dissection.
From January 2011 to December 2013, 67 patients who underwent thoracic endovascular aortic repair for DeBakey IIIb aortic dissection were retrospectively investigated. We assessed preoperative thoracic false lumen branches and diameter measurements at the level of the tracheal carina. Patients with a median follow-up of 12.2 months (interquartile range, 4.3-26.6 months) were categorized into 2 groups based on a receiver operating characteristic curve analysis: group A (preoperative thoracic false lumen branches ≥8, n = 28) and group B (preoperative thoracic false lumen branches <8, n = 39). Diameter changes over time were evaluated using a mixed model approach. A multivariate Cox regression analysis was used to study the influence of the preoperative thoracic false lumen branches on thoracic aortic enlargement along the stent graft.
Six patients experienced thoracic aortic enlargement along the stent graft during follow-up (6 in group A, 0 in group B). The cumulative thoracic aortic enlargement along the stent-graft rate was higher in group A than in group B (log-rank P < .01). Diameter data showed significantly more reduction of the thoracic false lumen from preprocedure to 12 months in group B than in group A (change difference, 2.51; standard error, 0.99; P = .01). Complete false lumen thrombosis was more prominent in group B than in group A at each follow-up time point. After multivariate adjustment, preoperative thoracic false lumen branches were associated with thoracic aortic enlargement along the stent graft (hazard ratio, 2.92; 95% confidence interval, 1.06-8.01).
Preoperative thoracic false lumen branches are a morphologic predictor of thoracic aortic enlargement along the stent graft in DeBakey IIIb aortic dissection after thoracic endovascular aortic repair.
本研究旨在评估术前胸主动脉假腔分支对胸主动脉夹层 DeBakey IIIb 型患者经胸主动脉腔内修复术后支架移植物内胸主动脉扩张的影响。
回顾性分析 2011 年 1 月至 2013 年 12 月期间 67 例接受胸主动脉腔内修复术治疗的 DeBakey IIIb 型主动脉夹层患者的临床资料。我们评估了术前胸主动脉假腔分支和气管隆突水平的直径测量值。67 例患者中位随访时间为 12.2 个月（四分位距：4.3-26.6 个月）。根据受试者工作特征曲线分析，将患者分为 2 组：A 组（术前胸主动脉假腔分支≥8 支，n=28）和 B 组（术前胸主动脉假腔分支<8 支，n=39）。采用混合模型方法评估随时间变化的直径变化。采用多变量 Cox 回归分析研究术前胸主动脉假腔分支对支架移植物内胸主动脉扩张的影响。
随访期间共有 6 例患者出现支架移植物内胸主动脉扩张（A 组 6 例，B 组 0 例）。A 组支架移植物内胸主动脉扩张率高于 B 组（log-rank P<.01）。与 A 组相比，B 组在术前至 12 个月时胸主动脉假腔的直径数据显示出明显更大的减少（差异为 2.51，标准误差为 0.99，P=.01）。在每个随访时间点，B 组的完全假腔血栓形成均比 A 组更明显。多变量调整后，术前胸主动脉假腔分支与支架移植物内胸主动脉扩张相关（危险比，2.92；95%置信区间，1.06-8.01）。
术前胸主动脉假腔分支是胸主动脉夹层 DeBakey IIIb 型患者经胸主动脉腔内修复术后支架移植物内胸主动脉扩张的形态学预测因素。
