Cheng Li, Xiang Dongqiao, Zhang Shan, Zheng Chuansheng, Wu Xiaoyan
Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
J Clin Med. 2023 Feb 10;12(4):1418. doi: 10.3390/jcm12041418.
Data are scarce regarding the incidence, reasons, potential risk factors, and long-term outcomes of reintervention after thoracic endovascular aortic repair (TEVAR) in patients with uncomplicated type B aortic dissection (TBAD).
Between January 2010 and December 2020, 238 patients with uncomplicated TBAD who received TEVAR were analyzed retrospectively. The clinical baseline data, aorta anatomy, dissection characteristics, and details of the TEVAR procedure were evaluated and compared. A competing-risk regression model was used to estimate the cumulative incidences of reintervention. The multivariate Cox model was used to identify the independent risk factors.
The mean follow-up time was 68.6 months. A total of 27 (11.3%) cases of reintervention were observed. The competing-risk analyses showed that the 1-, 3-, and 5-year cumulative incidences of reintervention were 5.07%, 7.08%, and 14.0%, respectively. Reasons for reintervention included endoleak (25.9%), aneurysmal dilation (22.2%), retrograde type A aortic dissection (18.5%), distal stent-graft-induced new entry and false lumen expansion (18.5%), and dissection progression and/or malperfusion (14.8%). Multivariable Cox analysis demonstrated that a larger initial maximal aortic diameter (Hazard ratio [HR], 1.75; 95% Confidence interval [CI], 1.13-2.69, = 0.011) and increased proximal landing zone oversizing (HR, 1.07; 95% CI, 1.01-1.47, = 0.033) were the significant risk factors for reintervention. Long-term survival rates were comparable between patients with or without reintervention ( = 0.915).
Reintervention after TEVAR in patients with uncomplicated TBAD is not uncommon. A larger initial maximal aortic diameter and excessive proximal landing zone oversizing are associated with the second intervention. Reintervention does not significantly affect long-term survival.
关于单纯B型主动脉夹层（TBAD）患者接受胸主动脉腔内修复术（TEVAR）后再次干预的发生率、原因、潜在风险因素和长期结局的数据较少。
回顾性分析2010年1月至2020年12月期间238例接受TEVAR的单纯TBAD患者。评估并比较临床基线数据、主动脉解剖结构、夹层特征和TEVAR手术细节。采用竞争风险回归模型估计再次干预的累积发生率。采用多变量Cox模型确定独立风险因素。
平均随访时间为68.6个月。共观察到27例（11.3%）再次干预病例。竞争风险分析显示，再次干预的1年、3年和5年累积发生率分别为5.07%、7.08%和14.0%。再次干预的原因包括内漏（25.9%）、动脉瘤样扩张（22.2%）、逆行性A型主动脉夹层（18.5%）、远端覆膜支架引起的新破口和假腔扩大（18.5%）以及夹层进展和/或灌注不良（14.8%）。多变量Cox分析表明，初始最大主动脉直径较大（风险比[HR]，1.75；95%置信区间[CI]，1.13 - 2.69，P = 0.011）和近端锚定区过大（HR，1.07；95%CI，1.01 - 1.47，P = 0.033）是再次干预的显著风险因素。有或无再次干预患者的长期生存率相当（P = 0.915）。
单纯TBAD患者TEVAR术后再次干预并不少见。初始最大主动脉直径较大和近端锚定区过大与二次干预相关。再次干预对长期生存无显著影响。
