Son Shin-Ah, Lee Deok Heon, Oh Tak-Hyuk, Cho Joon Yong, Lee Young Ok, Kim Young Eun, Kim Jung Won, Kim Gun-Jik
1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
Vasc Endovascular Surg. 2019 Apr;53(3):181-188. doi: 10.1177/1538574418814989. Epub 2018 Dec 13.
: Thoracic endovascular aortic repair (TEVAR) is associated with several short-term benefits, including reduced morbidity and mortality; however, the long-term durability of TEVAR and the need for secondary aortic reintervention remain unclear. We aimed to determine the adverse outcomes, including aortic reintervention, after TEVAR for thoracic aortic aneurysms and dissection.
: Between October 2009 and July 2016, 130 patients underwent TEVAR at Kyungpook National University Hospital. We excluded 35 patients with traumatic injury and included the remaining 95 patients in our study after TEVAR. The patients included in this study were categorized into 2 groups (reintervention [R] and nonintervention [N] groups) according to the need for reintervention. The mean follow-up period for all 95 patients was 22.4 (20.6) months.
: The overall actuarial survival rates were 83.7% (4.1%) and 63.6% (8.8%) at 1 and 5 years, respectively. The rates of freedom from aortic reintervention after TEVAR were 94.0% (3.5%), 72.8% (8.2%), and 48.9% (10.5%) at 2, 3, and 5 years, respectively. The independent risk factors for aortic reintervention were endoleaks after TEVAR (odds ratio [OR] 6.13, P = .017), increase in aortic size by over 5% per year (OR 20.40, P = .001), and peripheral vascular occlusive disease (PVOD; OR 13.62, P = .007). Patients with preoperative hemoptysis tended to show a greater need for aortic reintervention ( P = .059). Increase in aortic size by over 5% per year and PVOD were the primary risk factors for endoleaks (OR 3.82, P = .013 and OR 4.37, P = .021, respectively).
: Survival after TEVAR for thoracic aortic pathologies was satisfactory in most of the patients chosen as candidates for the procedure. However, the occurrence of endoleaks, increase in aortic size by over 5% per year, and PVOD were the primary causes of aortic reintervention.
胸主动脉腔内修复术（TEVAR）具有多项短期益处，包括降低发病率和死亡率；然而，TEVAR的长期耐久性以及二次主动脉再干预的必要性仍不明确。我们旨在确定TEVAR治疗胸主动脉瘤和夹层后的不良结局，包括主动脉再干预情况。
2009年10月至2016年7月期间，庆北国立大学医院有130例患者接受了TEVAR治疗。我们排除了35例创伤性损伤患者，将其余95例接受TEVAR治疗后的患者纳入本研究。根据再干预需求，将本研究纳入的患者分为两组（再干预[R]组和非干预[N]组）。所有95例患者的平均随访期为22.4（20.6）个月。
1年和5年时的总体精算生存率分别为83.7%（4.1%）和63.6%（8.8%）。TEVAR术后无主动脉再干预的发生率在2年、3年和五年时分别为94.0%（3.5%）、72.8%（8.2%）和48.9%（10.5%）。主动脉再干预的独立危险因素为TEVAR术后内漏（比值比[OR]6.13，P = 0.017）、主动脉直径每年增加超过5%（OR 20.40，P = 0.001）以及外周血管闭塞性疾病（PVOD；OR 13.62，P = 0.007）。术前咯血的患者往往更需要进行主动脉再干预（P = 0.059）。主动脉直径每年增加超过5%和PVOD是内漏的主要危险因素（分别为OR 3.82，P = 0.013和OR 4.37，P = 0.021）。
对于大多数被选为TEVAR手术候选者而言，TEVAR治疗胸主动脉病变后的生存率令人满意。然而，内漏的发生、主动脉直径每年增加超过5%以及PVOD是主动脉再干预的主要原因。
