分支型支架移植物治疗胸腹主动脉瘤的即刻和急诊疗效。
Early outcomes of t-Branch off-the-shelf multibranched stent graft in urgent and emergent repair of thoracoabdominal aortic aneurysms.
机构信息
German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany.
German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany.
出版信息
J Vasc Surg. 2022 Feb;75(2):416-424.e2. doi: 10.1016/j.jvs.2021.07.237. Epub 2021 Sep 1.
OBJECTIVE
We compared the outcomes between elective, urgent, and emergent treatment of thoracoabdominal aortic aneurysms (TAAAs) using the t-Branch off-the-shelf multibranched stent graft (Cook Medical, Bloomington, Ind).
METHODS
All consecutive patients treated for TAAAs using the t-Branch between September 2012 and June 2019 were included in the present study. The patients were divided into three groups according to the urgency of repair: (1) elective, (2) urgent, and (3) emergent. The periprocedural details and 30-day outcomes were analyzed. Survival and reinterventions were analyzed using Kaplan-Meier curves and log-rank tests.
RESULTS
The t-Branch stent graft was used for 100 patients during the study period. Of the 100 patients, 30 (73% male; mean age, 65 ± 10 years) were treated electively, 49 (54% male; mean age, 72 ± 7 years) urgently, and 21 (81% male; mean age, 75 ± 9 years) emergently. Transfemoral access with a steerable sheath was used more frequently for target vessel catheterization in the elective group (57%) than in the urgent (8%) and emergent (5%) groups (P = .021). The total number of targeted vessels was 111 of 120 (93%) in the elective group vs 185 of 196 (94%) in the urgent group and 82 of 84 (98%) in the emergent group. The corresponding technical success rates were 97% (29 of 30), 98% (48 of 49), and 95% (20 of 21). The median intensive care unit stay was shorter in the elective group (3 days; range, 1-41 days) than in the urgent group (5 days; range, 1-41 days) and emergent group (11 days; range, 3-37 days; P = .004). The 30-day mortality rate was lower in the elective group (2 of 30; 7%) than in the urgent group (8 of 49; 16%) and emergent group (5 of 21; 24%; P = .049). The acute kidney injury rate was lower in the elective group (2 of 30; 7%) than in the urgent group (11 of 49; 22%) and emergent group (8 of 21; 38%; P = .002). The spinal cord ischemia rate was also lower in the elective group (5 of 30; 17%) than in the urgent group (5 of 49; 10%) and emergent group (8 of 21; 38%; P = .051). The median follow-up was 8 months (interquartile range, 3.2-18.5 months). The cumulative survival rate was 95%, 87%, and 87% at 6, 12, and 24 months, respectively. The cumulative freedom from reintervention during follow-up was 92%, 86%, and 77% at 6, 12, and 24 months, respectively.
CONCLUSIONS
The technical success of TAAA repair using t-Branch stent graft was not affected by an urgent or emergent presentation. However, the occurrence of worse periprocedural morbidity and mortality was significantly associated with an urgent or emergent presentation.
目的
本研究比较了使用 t-Branch 分支型覆膜支架（库克医疗公司，印第安纳州布卢明顿）治疗胸腹主动脉瘤（TAAA）时择期、紧急和急诊治疗的结果。
方法
本研究纳入了 2012 年 9 月至 2019 年 6 月期间使用 t-Branch 治疗 TAAA 的所有连续患者。根据修复的紧急程度，患者被分为三组：（1）择期，（2）紧急，（3）急诊。分析围手术期细节和 30 天结局。使用 Kaplan-Meier 曲线和对数秩检验分析生存率和再介入情况。
结果
研究期间，t-Branch 支架共用于 100 例患者。100 例患者中，30 例（73%为男性；平均年龄 65±10 岁）为择期治疗，49 例（54%为男性；平均年龄 72±7 岁）为紧急治疗，21 例（81%为男性；平均年龄 75±9 岁）为急诊治疗。在目标血管导管插入时，经股动脉入路使用可转向鞘更常用于择期组（57%），而紧急组（8%）和急诊组（5%）较少使用（P=.021）。择期组有 111 个（93%）目标血管，紧急组有 185 个（94%），急诊组有 82 个（98%）。相应的技术成功率分别为 97%（29 例）、98%（48 例）和 95%（20 例）。择期组的 ICU 中位住院时间（3 天；范围，1-41 天）短于紧急组（5 天；范围，1-41 天）和急诊组（11 天；范围，3-37 天；P=.004）。择期组的 30 天死亡率（2 例[7%]）低于紧急组（8 例[16%]）和急诊组（5 例[24%]；P=.049）。择期组的急性肾损伤发生率（2 例[7%]）低于紧急组（11 例[22%]）和急诊组（8 例[38%]；P=.002）。择期组的脊髓缺血发生率（5 例[17%]）也低于紧急组（5 例[10%]）和急诊组（8 例[38%]；P=.051）。中位随访时间为 8 个月（四分位间距，3.2-18.5 个月）。6、12 和 24 个月时的累积生存率分别为 95%、87%和 87%。6、12 和 24 个月时的累积无再介入率分别为 92%、86%和 77%。
结论
使用 t-Branch 分支型覆膜支架治疗 TAAA 的技术成功率不受紧急或急诊表现的影响。然而，围手术期严重发病率和死亡率的发生与紧急或急诊表现显著相关。
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