Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa.
Division of Vascular Surgery and Endovascular Therapy, University of Alabama Birmingham Hospital, Birmingham, Ala.
J Vasc Surg. 2020 Feb;71(2):408-422. doi: 10.1016/j.jvs.2019.04.484. Epub 2019 Jul 18.
Using a national data set, we sought to describe the population of patients and the nature and timing of reinterventions after thoracic endovascular aortic repair (TEVAR) by aortic disease as well as their impact on survival.
We evaluated the national data set for TEVAR in the Vascular Quality Initiative from 2010 to 2017. Student t-test and χ analysis were used to compare continuous and categorical variables in the reintervention and no reintervention groups, respectively. Freedom from reintervention and survival analysis was performed using Kaplan-Meier methods.
A total of 7006 patients were evaluated: 51.2% thoracic aortic aneurysm, 33.5% type B dissection (TBD), 7.0% penetrating aortic ulcer, 6.7% trauma, and 1.6% intramural hematoma. Overall, 553 patients (7.9%) underwent at least one reintervention, with an in-hospital reintervention rate of 3.5%. Reinterventions were most commonly performed for TBD (11.5%), with reinterventions for other diseases occurring at lower rates: thoracic aortic aneurysm, 6.7%; intramural hematoma, 5.4%; penetrating aortic ulcer, 4.8%; and trauma, 1.8%. The most common cause of reintervention across all aortic diseases was type I endoleak. The most common long-term reinterventions were placement of endovascular stent graft (65%), other surgical treatments (15.9%), other endovascular treatment (13%), endovascular branch treatment (12.4%), surgical treatment with no device removal (11.0%), and surgical branch treatment (10.4%). Freedom from reintervention was decreased for TBD compared with other diseases (P < .001). There was no difference in survival comparing patients undergoing reinterventions and those without (P = .87). However, patients undergoing in-hospital reintervention trended toward increased mortality (P = .075).
Whereas reinterventions were not rare after TEVAR, there was no difference in mortality between patients undergoing reintervention and those without. Patients undergoing TEVAR for TBD demonstrated the highest reintervention rate. This study highlights the importance of long-term follow-up to address disease-specific patterns of reintervention.
利用国家数据集，我们旨在描述胸主动脉腔内修复术（TEVAR）后因主动脉疾病而进行的患者人群以及再干预的性质和时间，并探讨其对生存的影响。
我们评估了 2010 年至 2017 年血管质量倡议（VQI）中的 TEVAR 国家数据集。分别使用学生 t 检验和卡方分析比较再干预组和非再干预组的连续和分类变量。使用 Kaplan-Meier 方法进行无再干预和生存分析。
共评估了 7006 例患者：51.2%为胸主动脉瘤，33.5%为 B 型夹层（TBD），7.0%为穿透性主动脉溃疡，6.7%为创伤，1.6%为壁内血肿。总体而言，553 例（7.9%）患者至少进行了一次再干预，住院期间再干预率为 3.5%。TBD 的再干预最为常见（11.5%），其他疾病的再干预发生率较低：胸主动脉瘤为 6.7%，壁内血肿为 5.4%，穿透性主动脉溃疡为 4.8%，创伤为 1.8%。所有主动脉疾病的再干预最常见的原因是Ⅰ型内漏。最常见的长期再干预措施是放置血管内支架移植物（65%），其他手术治疗（15.9%），其他血管内治疗（13%），血管内分支治疗（12.4%），无器械移除的手术治疗（11.0%）和手术分支治疗（10.4%）。与其他疾病相比，TBD 的无再干预率降低（P<.001）。比较再干预患者和未再干预患者的生存率，差异无统计学意义（P=.87）。然而，住院期间行再干预的患者死亡率有升高趋势（P=.075）。
虽然 TEVAR 后再干预并不罕见，但再干预患者与未再干预患者的死亡率无差异。TBD 行 TEVAR 的患者再干预率最高。本研究强调了长期随访以解决特定疾病再干预模式的重要性。
