Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Ann Thorac Surg. 2022 Sep;114(3):684-692. doi: 10.1016/j.athoracsur.2022.01.028. Epub 2022 Feb 10.
Stent graft-induced new entry has been described in thoracic endovascular aortic repair for aortic dissection. The incidence of stent graft-induced aortic wall injury (SAWI) related to iatrogenic injury in nondissections is incompletely described. We describe incidence, risk factors, and outcomes of SAWI.
All post-thoracic endovascular aortic repair computed tomography angiograms (January 2005 to December 2018) were reviewed for radiographic evidence of SAWI. Endograft-induced aortic dissections were likewise considered SAWI. Patient characteristics, time to SAWI, and need for reintervention were noted. Cox proportional hazards modeling was used to identify risk factors for SAWI.
Within the study cohort (n = 430), 38 patients (9%) had SAWI during a median follow-up of 2.3 years (interquartile range, 4.8); 42% (n = 16) were proximal, 53% (n = 20) distal, and 5% (n = 2) both proximal and distal. Nine (23%) were distal intimal flap injuries in dissection cases, thus subclassifying them as stent graft-induced new entry. Twenty-nine percent of SAWI (n = 11) required reintervention. Of these, 45% (n = 5) were open, and 55% (n = 6) were endovascular. Thoracic endovascular aortic repair for acute dissection had a higher incidence of SAWI development (hazard ratio 4.6; 95% confidence interval, 2.4 to 9; P < .001) as compared with other indications. Use of devices with proximal bare springs or barbs was also associated with increased SAWI incidence (hazard ratio 5.3; 95% confidence interval, 2.6 to 11.0; P < .001).
The rate of SAWI after thoracic endovascular aortic repair is low (9%), but nearly one third will require reintervention. Thoracic endovascular aortic repair in the setting of acute dissection and use of devices with proximal bare springs or barbs were associated with an increased incidence of SAWI.
胸主动脉腔内修复术（TEVAR）治疗主动脉夹层时，已描述过支架移植物导致的新入口（stent graft-induced new entry）。非夹层病变中，支架移植物致主动脉壁损伤（stent graft-induced aortic wall injury，SAWI）与医源性损伤相关的发病率尚未完全描述。本研究描述了 SAWI 的发病率、危险因素和转归。
回顾性分析 2005 年 1 月至 2018 年 12 月所有 TEVAR 后 CT 血管造影（CTA）的影像学资料，以明确 SAWI 的影像学证据。同样，将移植物导致的主动脉夹层也视为 SAWI。记录患者特征、SAWI 发生时间及再次干预需求。采用 Cox 比例风险模型识别 SAWI 的危险因素。
在研究队列中（n=430），38 例患者（9%）在中位 2.3 年（四分位距，4.8）的随访中发生 SAWI；42%（n=16）为近端，53%（n=20）为远端，5%（n=2）为近端和远端。9 例（23%）为夹层病例中的远端内膜瓣损伤，因此将其分类为支架移植物导致的新入口。29%的 SAWI（n=11）需要再次干预。其中，45%（n=5）为开放手术，55%（n=6）为血管内治疗。急性夹层 TEVAR 的 SAWI 发生率较高（风险比 4.6；95%置信区间，2.4 至 9；P<0.001）。近端裸弹簧或倒刺的支架移植物的使用也与 SAWI 发生率增加相关（风险比 5.3；95%置信区间，2.6 至 11.0；P<0.001）。
TEVAR 后 SAWI 的发生率较低（9%），但近 1/3 的患者需要再次干预。急性夹层 TEVAR 和使用近端裸弹簧或倒刺的支架移植物与 SAWI 发生率增加相关。
