Vascular Surgery - Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Sant'Orsola-Malpighi, Bologna, Italy.
Eur J Vasc Endovasc Surg. 2020 Aug;60(2):203-209. doi: 10.1016/j.ejvs.2020.04.015. Epub 2020 May 10.
The Global Registry for Endovascular Aortic Treatment (GREAT), a retrospective sponsored registry, was queried to determine the incidence and identify potential predictors of access related complications after TEVAR.
This is a multicentre, observational cohort study. For the current study, all patients were treated only with the Conformable GORE® TAG® Thoracic Endoprosthesis and GORE® TAG® Thoracic Endoprosthesis devices for any kind of thoracic aortic disease. All serious adverse events within 30 days of the procedure were documented by sites. The following were considered access related complications: surgical site infection, pseudoaneurysm, avulsion, dissection, arterial bleeding, access vessel thrombosis/occlusion, seroma, and lymphocoele.
A total of 887 patients was analysed: most of the cases had an operative indication for TEVAR of degenerative atherosclerotic aneurysm (n = 414, 46.7%) and type B dissection (n = 270, 30.4% either complicated or uncomplicated). Two hundred and ninety-five patients (33.3%) were female. The overall access related complication rate was 2.8% (n = 25): 4.7% (n = 14) in women and 1.8% (n = 11) in men (p = .013). After adjustment for age, urgency, device diameter, introducer sheath (≥24Fr vs. ≤ 24Fr), access vessel diameters, and access method, female gender was significantly associated with the risk of access complications (OR 2.85; p = .038). Brachial artery for access was also found to be an independent predictor of access related complications (OR 8.32; p < .001).
This analysis suggests that women may have a higher access related complication rate after TEVAR, irrespective of the clinical setting, type of aortic disease, and device sizing.
全球血管内主动脉治疗登记处（GREAT）是一项回顾性赞助登记处，通过该登记处调查了 TEVAR 后发生血管入路相关并发症的发生率，并确定了其潜在预测因素。
这是一项多中心观察性队列研究。在本研究中，所有患者均仅使用顺应性戈尔®TAG®胸主动脉覆膜支架和戈尔®TAG®胸主动脉覆膜支架治疗任何类型的胸主动脉疾病。所有术后 30 天内的严重不良事件均由各研究中心记录。入路相关并发症包括手术部位感染、假性动脉瘤、撕脱、夹层、动脉出血、入路血管血栓/闭塞、血清肿和淋巴囊肿。
共分析了 887 例患者：大多数病例的 TEVAR 手术适应证为退行性动脉粥样硬化性动脉瘤（n=414，46.7%）和 B 型夹层（n=270，单纯或不单纯 B 型夹层分别占 30.4%）。295 例（33.3%）为女性。总的血管入路相关并发症发生率为 2.8%（n=25）：女性为 4.7%（n=14），男性为 1.8%（n=11）（p=0.013）。调整年龄、紧急程度、器械直径、导入鞘（≥24Fr 与≤24Fr）、入路血管直径和入路方法后，女性性别与血管入路并发症风险显著相关（OR 2.85；p=0.038）。股动脉入路也被发现是血管入路相关并发症的独立预测因素（OR 8.32；p<0.001）。
本分析表明，女性在 TEVAR 后发生血管入路相关并发症的风险可能更高，无论临床情况、主动脉疾病类型和器械尺寸如何。
