Department of Vascular and Endovascular Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China.
Research Platform for Minimally Invasive Cardiovascular Surgery, Beijing Key Laboratory, Beijing, China.
Interact Cardiovasc Thorac Surg. 2020 Nov 1;31(5):680-687. doi: 10.1093/icvts/ivaa184.
This study was performed to assess the association between the dissection length-to-descending thoraco-abdominal aorta length ratio (LLR) and abdominal aortic enlargement (AAE) (≥20% increase in total abdominal aortic volume) after thoracic endovascular aortic repair (TEVAR) in patients with type B aortic dissection.
We retrospectively analysed data from 184 consecutive patients with type B aortic dissection who underwent TEVAR from January 2011 to December 2016 at 4 hospitals as part of the Registry Of type B aortic dissection with Utility of STent graft study. Preoperative and postoperative computed tomography angiography images were reviewed to assess the LLR and AAE. Patients were stratified into tertiles according to the pre-TEVAR LLR: 0.7 to <1.0 (n = 61), 1.0 to <1.2 (n = 61) and 1.2 to <1.6 (n = 62). The thoracic and abdominal aorta were divided by the celiac trunk. The cumulative incidence of AAE was estimated using the Kaplan-Meier method. A multivariable Cox proportional hazards model was used to assess the independent association between the preoperative LLR and the post-TEVAR risk of AAE. The nonlinear relationship between the LLR and the risk of post-TEVAR AAE was fitted by the restricted cubic smoothing spline, and the inflection point on the fitting curve was determined using a piecewise linear regression model.
Baseline demographics, clinical features, preoperative anatomic characteristics and implanted devices were similarly distributed among the pre-TEVAR LLR tertile groups. At 24 months post-TEVAR, the estimated cumulative incidence of AAE significantly differed (P < 0.01) by LLR tertile group: 0.10 [95% confidence interval (CI) 0.00-0.21], 0.65 (95% CI 0.45-0.78) and 0.67 (95% CI 0.40-0.82), respectively. The pre-TEVAR LLR was an independent predictor of post-TEVAR AAE [hazard ratio (per unit increase) 1.03, 95% CI 1.01-1.04] following a nonlinear relationship with an inflection point at LLR = 1.0.
The risk of post-TEVAR AAE is highest when the length of the dissection is greater than or equal to the length of the descending aorta (LLR ≥ 1.0).
本研究旨在评估在接受胸主动脉腔内修复术（TEVAR）治疗的 B 型主动脉夹层患者中，夹层长度与降主动脉长度之比（LLR）与腹主动脉扩大（AAE）（总腹主动脉体积增加≥20%）之间的相关性。
我们回顾性分析了 2011 年 1 月至 2016 年 12 月期间，4 家医院的 184 例 B 型主动脉夹层患者的连续数据，这些患者是 B 型主动脉夹层与支架植入术的实用研究注册（Registry Of type B aortic dissection with Utility of STent graft study）的一部分。使用计算机断层血管造影术评估术前和术后的 LLR 和 AAE。根据术前 TEVAR 的 LLR 将患者分层为三个三分位组：0.7 至<1.0（n=61），1.0 至<1.2（n=61）和 1.2 至<1.6（n=62）。用腹腔干将胸主动脉和腹主动脉分开。使用 Kaplan-Meier 方法估计 AAE 的累积发生率。使用多变量 Cox 比例风险模型评估术前 LLR 与 TEVAR 后 AAE 风险之间的独立关联。使用受限立方样条拟合 LLR 与 TEVAR 后 AAE 风险之间的非线性关系，并使用分段线性回归模型确定拟合曲线上的拐点。
在接受 TEVAR 治疗前，LLR 三分位组之间的基线人口统计学、临床特征、术前解剖特征和植入装置的分布相似。在 TEVAR 后 24 个月，AAE 的估计累积发生率因 LLR 三分位组而显著不同（P<0.01）：0.10（95%置信区间 0.00-0.21），0.65（95%置信区间 0.45-0.78）和 0.67（95%置信区间 0.40-0.82）。术前 LLR 是 TEVAR 后 AAE 的独立预测因子[每单位增加的危险比（per unit increase）1.03，95%置信区间 1.01-1.04]，与 LLR=1.0 处的拐点呈非线性关系。
当夹层长度等于或大于降主动脉长度（LLR≥1.0）时，TEVAR 后发生 AAE 的风险最高。
