Cardiac Surgery, Cardiocentro Ticino Institute, EOC, Lugano, Switzerland.
Centro Vascolare Ticino, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland; Universitätsinstitut für Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Universitätsspital Bern, Bern, Switzerland.
Ann Vasc Surg. 2023 Aug;94:362-368. doi: 10.1016/j.avsg.2023.02.012. Epub 2023 Mar 11.
Thoracic endovascular aortic repair (TEVAR) has become a standard treatment for acute and chronic thoracic aorta diseases. We analyzed long-term outcomes and risk factors of TEVAR procedures according to the aortic pathology.
Demographics, indications, technical details, and outcomes of patients undergoing TEVAR procedures in our institutions were prospectively collected and retrospectively analyzed. Overall survival was determined using Kaplan-Meier methods while log-rank tests were used to compare the survival between groups. Cox regression analysis was used to identify risk factors.
Between June 2002 and April 2020, 116 patients underwent TEVAR for different thoracic aorta diseases. Among them, 47 patients (41%) underwent TEVAR for aneurysmatic aortic disease, 26 (22%) for type-B aortic dissection, 23 (20%) for penetrating aortic ulcer, 11 (9%) after previous type-A dissection treatment, and 9 (8%) for traumatic aortic injury. Patients with posttraumatic aortic injury were younger (P < 0.01) with less hypertension (P < 0.01), diabetes (P < 0.01), and prior cardiac surgery (P < 0.01). Survival was different based on indication for TEVAR (log rank 0.024). Patients after previous type-A dissection treatment had the worst survival rate (50% at 5 years) while survival for aneurysmatic aortic disease was 55% at 5 years. No late death occurred in the traumatic group. Cox-regression model identified independent predictors for mortality: age (hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 1.01-1.09, P = 0.006), male gender (HR: 3.2, 95% CI: 1.1-9.2, P = 0.028), moderate chronic obstructive pulmonary disease (HR: 2.1, 95% CI: 1.02-4.55, P = 0.043), previous cardiac surgery (HR: 2.1, 95% CI: 1.008-4.5, P = 0.048), and treatment indication for aneurysm (HR: 2.6, 95% CI: 1.2-5.2, P = 0.008).
TEVAR is a safe and effective procedure with excellent long-term results in case of traumatic aortic injury. The overall long-term survival is affected by aortic pathology, associated comorbidities, gender, and previous cardiac surgery.
胸主动脉腔内修复术（TEVAR）已成为急性和慢性胸主动脉疾病的标准治疗方法。我们根据主动脉病理学分析了 TEVAR 手术的长期结果和危险因素。
前瞻性收集并回顾性分析了我院行 TEVAR 手术患者的人口统计学、适应证、技术细节和结果。使用 Kaplan-Meier 方法确定总生存率，使用对数秩检验比较组间生存率。使用 Cox 回归分析确定危险因素。
2002 年 6 月至 2020 年 4 月，116 例患者因不同的胸主动脉疾病行 TEVAR 治疗。其中，47 例（41%）因动脉瘤性主动脉疾病行 TEVAR，26 例（22%）因 B 型主动脉夹层，23 例（20%）因穿透性主动脉溃疡，11 例（9%）因既往 A 型夹层治疗后，9 例（8%）因创伤性主动脉损伤。创伤性主动脉损伤患者更年轻（P<0.01），高血压（P<0.01）、糖尿病（P<0.01）和既往心脏手术（P<0.01）较少。TEVAR 的适应证不同，生存率也不同（对数秩检验，P=0.024）。既往 A 型夹层治疗后患者的生存率最差（5 年时为 50%），而动脉瘤性主动脉疾病的生存率为 55%。创伤组无晚期死亡。Cox 回归模型确定了死亡率的独立预测因素：年龄（危险比 [HR]：1.05，95%置信区间 [CI]：1.01-1.09，P=0.006）、男性（HR：3.2，95% CI：1.1-9.2，P=0.028）、中度慢性阻塞性肺疾病（HR：2.1，95% CI：1.02-4.55，P=0.043）、既往心脏手术（HR：2.1，95% CI：1.008-4.5，P=0.048）和动脉瘤治疗指征（HR：2.6，95% CI：1.2-5.2，P=0.008）。
TEVAR 是一种安全有效的治疗方法，创伤性主动脉损伤的长期效果极佳。总体长期生存率受主动脉病理、合并症、性别和既往心脏手术的影响。
