Hellgren Tina, Beck Adam W, Behrendt Christian-Alexander, Becker Daniel, Beiles Barry, Boyle Jonathan R, Jormalainen Mikko, Koncar Igor, Lopez Espada Cristina, Setacci Carlo, Settembre Nicla, Sutzko Danielle C, Szeberin Zoltan, Thomson Ian, Venermo Maarit, Mani Kevin
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, Alabama.
Ann Surg. 2022 Nov 1;276(5):e598-e604. doi: 10.1097/SLA.0000000000004561. Epub 2020 Nov 17.
To assess practice patterns and short-term outcome after thoracic endovascular aortic repair (TEVAR), based on an international vascular registry collaboration.
TEVAR has become the primary surgical treatment modality for descending aortic pathologies, and has expanded to new patient cohorts, including the elderly.
Data on thoracic aortic aneurysms (TAA), type B aortic dissections (TBAD), and traumatic aortic injuries (TAI) treated with TEVAR from 2012 to 2016 were retrieved from registries and centers in 13 countries.
Nine-thousand five-hundred eighteen TEVAR for TAA ( n = 4436), TBAD ( n = 3976) and TAI ( n = 1106) were included. The distribution of TEVAR procedures per pathology varied, with TAA repair constituting from 40% of TEVARs in the US to 72% in the UK ( P < 0.001).Mean intact TAA (iTAA) diameter varied from 59 (US) to 69 mm (Nancy, France) ( P < 0.001), 25.3% of patients having a diameter of <60 mm. Perioperative mortality after iTAA repair was 4.9%; combined mortality, stroke, paraplegia, and renal replacement therapy outcome was 12.8%. 18.6% of iTAA patients were ≥80 years old. Mortality was higher in this group (7.2%) than in patients <80 (3.8%) ( P < 0.001). After rTAA repair, perioperative mortality was 26.8%.Mortality was 9.7% after acute (within 14 days from onset of dissection) and 3.0% after chronic TBAD repair ( P < 0.001). Mortality after TAI was 7.8%, and depended on injury severity (grade IV (free rupture) 20.9%).
This registry collaboration provides a unique platform to evaluate cross-border patterns of use and outcomes of TEVAR. A common core dataset is proposed, to achieve harmonization of registry-based quality outcome measures for TEVAR.
基于一项国际血管注册研究合作，评估胸主动脉腔内修复术（TEVAR）后的实践模式和短期结局。
TEVAR已成为降主动脉病变的主要外科治疗方式，并已扩展至包括老年人在内的新患者群体。
从13个国家的注册研究和中心检索2012年至2016年接受TEVAR治疗的胸主动脉瘤（TAA）、B型主动脉夹层（TBAD）和创伤性主动脉损伤（TAI）的数据。
纳入了9518例针对TAA（n = 4436）、TBAD（n = 3976）和TAI（n = 1106）的TEVAR。每种病变的TEVAR手术分布各异，TAA修复在美国占TEVAR的40%，在英国占72%（P < 0.001）。完整TAA（iTAA）的平均直径从59毫米（美国）到69毫米（法国南锡）不等（P < 0.001），25.3%的患者直径<60毫米。iTAA修复后的围手术期死亡率为4.9%；联合死亡率、中风、截瘫和肾脏替代治疗结局为12.8%。18.6%的iTAA患者年龄≥80岁。该组的死亡率（7.2%）高于<80岁的患者（3.8%）（P < 0.001）。rTAA修复后，围手术期死亡率为26.8%。急性TBAD（发病14天内）修复后的死亡率为9.7%，慢性TBAD修复后的死亡率为3.0%（P < 0.001）。TAI后的死亡率为7.8%，并取决于损伤严重程度（IV级（游离破裂）为20.9%）。
这项注册研究合作提供了一个独特的平台，用于评估TEVAR的跨境使用模式和结局。提出了一个通用的核心数据集，以实现基于注册研究的TEVAR质量结局指标的统一。
