Murana Giacomo, Di Marco Luca, Fiorentino Mariafrancesca, Buia Francesco, Brillanti Giorgia, Lovato Luigi, Pacini Davide
Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Cardiovascular Radiology Unit, Cardio-thoraco-vascular Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
JTCVS Open. 2022 Apr 4;10:12-21. doi: 10.1016/j.xjon.2022.03.003. eCollection 2022 Jun.
Thoracic endovascular aortic repair (TEVAR) is the treatment of choice for thoracic aorta diseases including penetrating aortic ulcer (PAU). The objective of this study was to analyze the results of TEVAR for the treatment of PAU in our population.
From January 1999 to January 2019, 830 patients with type B aortic syndromes were treated with TEVAR in our institution. Of these we selected 73 patients treated for a PAU. Clinical and radiologic follow-up was performed in all patients.
Mean age of our population was 72 ± 8 years. Fifteen patients (20.5%) were treated in an emergency setting. The proximal landing zone was in arch zone 2 in 22 patients (30.1%). In-hospital mortality was 6.8% and was associated with acute presentation ( = .005). Distal arch delivery of the endograft was unrelated to mortality (Fisher exact test, = .157). Survival at 1 and 5 years was 81.7% and 67.3%, respectively. Sixteen patients underwent reintervention of the thoracic aorta. Patients who underwent emergency surgery and older patients had a shorter survival (log rank test, < .001). No difference in survival was shown according to the proximal landing zone (log rank = .292) or the dimension of the thoracic aorta (log rank = .067). In multivariable Cox regression analysis, only age older than 75 years was associated with 5-year mortality (hazard ratio, 6.60; 95% CI, 2.12-20.56); < .001).
The use of TEVAR for treatment of aortic PAU is a safe procedure in an elective setting despite necessity of arch stent grafting. An early intervention performed at smaller aortic diameters of <55 mm might be beneficial in selected patients to improve late survival.
胸主动脉腔内修复术（TEVAR）是治疗包括穿透性主动脉溃疡（PAU）在内的胸主动脉疾病的首选治疗方法。本研究的目的是分析TEVAR治疗我国人群PAU的结果。
1999年1月至2019年1月，我院对830例B型主动脉综合征患者进行了TEVAR治疗。其中，我们选择了73例接受PAU治疗的患者。对所有患者进行了临床和影像学随访。
我们研究人群的平均年龄为72±8岁。15例患者（20.5%）在急诊情况下接受治疗。22例患者（30.1%）的近端锚定区位于主动脉弓2区。住院死亡率为6.8%，与急性发病相关（P = 0.005）。腔内移植物的远端主动脉弓输送与死亡率无关（Fisher精确检验，P = 0.157））。1年和5年生存率分别为81.7%和67.3%。16例患者接受了胸主动脉再次干预。接受急诊手术的患者和老年患者的生存期较短（对数秩检验，P < 0.001）。根据近端锚定区（对数秩P = 0.292）或胸主动脉尺寸（对数秩P = 0.067），生存率无差异。在多变量Cox回归分析中，只有年龄大于75岁与5年死亡率相关（风险比，6.60；95%可信区间，2.12 - 20.56；P < 0.001）。
尽管需要进行主动脉弓支架植入，但在择期情况下，使用TEVAR治疗主动脉PAU是一种安全的手术方法。对于选定的患者，在主动脉直径小于55 mm时进行早期干预可能有利于提高远期生存率。
