Hori Daijiro, Fujimori Tomonari, Kusadokoro Sho, Yamamoto Takahiro, Kimura Naoyuki, Yamaguchi Atsushi
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Front Physiol. 2021 Oct 22;12:739185. doi: 10.3389/fphys.2021.739185. eCollection 2021.
Endovascular treatment of aortic aneurysm is associated with an increase in pulse wave velocity (PWV) after surgery. However, the effect of different types of endovascular devices on PWV at different sites of the thoracic aorta remains unclear. The purposes of this study were (1) to investigate the changes in PWV after endovascular treatment of thoracic aortic aneurysm; (2) to evaluate whether there is a difference in the changes in PWV at different treatment sites; and (3) to evaluate the effect of treatment length on changes in PWV. From July 2008 to July 2021, 276 patients underwent endovascular treatment of the true thoracic aortic aneurysm. Of these patients, 183 patients who underwent preoperative and postoperative PWV measurement within 1 year of surgery were included in the study. The treatment length index was calculated by treatment length divided by the height of the patients. Five different types of endovascular devices were used (Najuta, Kawasumi Laboratories, Inc., Tokyo, Japan; TAG, W.L. Gore & Associates, Inc., AZ, USA; Relay, Bolton Medical, Inc., FL, USA; Talent/Valiant, Medtronic, MN, USA; and Zenith, Cook Medical, IN, USA). There was no significant change in PWV in patients receiving Najuta (Before: 2,040 ± 346.8 cm/s vs. After: 2,084 ± 390.5 cm/s, = 0.14). However, a significant increase was observed in other devices: TAG (Before: 2,090 ± 485.9 cm/s vs. After: 2,300 ± 512.1 cm/s, = 0.025), Relay (Before: 2,102 ± 465.3 cm/s vs. After: 2,206 ± 444.4 cm/s, = 0.004), Valiant (Before: 1,696 ± 330.2 cm/s vs. After: 2,186 ± 378.7 cm/s, < 0.001), and Zenith (Before: 2,084 ± 431.7 cm/s vs. After: 2,321 ± 500.6 cm/s, < 0.001). There was a significant increase in PWV in patients treated from aortic arch (Before: 2,006 ± 333.7 cm/s vs. After: 2,132 ± 423.7 cm/s, < 0.001) and patients treated from descending thoracic aorta (Before: 2,116 ± 460.9 cm/s vs. After: 2,292 ± 460.9 cm/s, < 0.001). Multivariate analysis showed that treatment site was not an independent factor associated with changes in PWV. However, Najuta (Coef -219.43, 95% CI -322.684 to -116.176, < 0.001) and treatment index (Coef 147.57, 95% CI 24.826 to 270.312, = 0.019) were independent factors associated with changes in PWV. Najuta did not show a significant increase in PWV, while other commercially available devices showed a significant increase. The treatment site did not have a different effect on PWV. However, the treatment length was an independent factor associated with an increase in PWV.
主动脉瘤的血管内治疗与术后脉搏波速度（PWV）增加有关。然而，不同类型的血管内装置对胸主动脉不同部位PWV的影响仍不清楚。本研究的目的是：（1）调查胸主动脉瘤血管内治疗后PWV的变化；（2）评估不同治疗部位PWV变化是否存在差异；（3）评估治疗长度对PWV变化的影响。2008年7月至2021年7月，276例患者接受了真性胸主动脉瘤的血管内治疗。其中，183例在术后1年内进行了术前和术后PWV测量的患者被纳入研究。治疗长度指数通过治疗长度除以患者身高计算得出。使用了五种不同类型的血管内装置（Najuta，日本东京河合制作所；TAG，美国亚利桑那州W.L. Gore & Associates公司；Relay，美国佛罗里达州博尔顿医疗公司；Talent/Valiant，美国明尼苏达州美敦力公司；Zenith，美国印第安纳州库克医疗公司）。接受Najuta治疗的患者PWV无显著变化（术前：2040±346.8cm/s，术后：2084±390.5cm/s，P = 0.14）。然而，其他装置观察到显著增加：TAG（术前：2090±485.9cm/s，术后：2300±512.1cm/s，P = 0.025）、Relay（术前：2102±465.3cm/s，术后：2206±444.4cm/s，P = 0.004）、Valiant（术前：1696±330.2cm/s，术后：2186±378.7cm/s，P < 0.001）和Zenith（术前：2084±431.7cm/s，术后：2321±500.6cm/s，P < 0.001）。从主动脉弓治疗的患者PWV显著增加（术前：2006±333.7cm/s，术后：2132±423.7cm/s，P < 0.001），从胸降主动脉治疗的患者PWV也显著增加（术前：2116±460.9cm/s，术后：2292±460.9cm/s，P < 0.001）。多因素分析显示，治疗部位不是与PWV变化相关的独立因素。然而，Najuta（系数-219.43，95%置信区间-322.684至-116.176，P < 0.001）和治疗指数（系数147.57，95%置信区间24.826至270.312，P = 0.019）是与PWV变化相关的独立因素。Najuta未显示PWV显著增加，而其他市售装置显示显著增加。治疗部位对PWV没有不同影响。然而，治疗长度是与PWV增加相关的独立因素。
