货架分支型 t-Branch 装置治疗女性患者的早期和中期结果。
Early and Mid-Term Outcomes of Females Treated with t-Branch off the Shelf Device.
机构信息
Department of Vascular Medicine, German Aortic Center, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany.
Department of Vascular Medicine, German Aortic Center, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany; Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
出版信息
Ann Vasc Surg. 2023 Sep;95:32-41. doi: 10.1016/j.avsg.2023.05.033. Epub 2023 Jun 1.
BACKGROUND
Female sex has been characterized as a risk factor of increased mortality in patients managed for complex aortic aneurysm using endovascular means. This study aimed to present the perioperative and follow-up outcomes of females managed electively or urgently with the t-Branch device and investigate factors affecting the early outcomes.
METHODS
A 2-center retrospective observational study was conducted including elective and urgent female patients managed with the t-Branch device (Cook Medical, Bjaeverskov, Denmark) for thoracoabdominal and pararenal aneurysms between January 1, 2018 and September 30, 2020. Primary early outcomes included technical success and 30-day mortality and morbidity [spinal cord ischemia (SCI) and acute kidney injury]. Follow-up survival and freedom from reintervention rates were assessed using Kaplan-Meier estimates.
RESULTS
In total, 153 females were included; 81 (52.9%) treated urgently. Urgent patients were older (73.2 ± 8.6 vs. 68.5 ± 6.8 years; P < 0.001) and presented higher previous coronary angioplasty/stenting (16.0% vs. 5.6%, P = 0.005) and lower double antiplatelet therapy (DAPT, 46.3% vs. 53.7%, P = 0.04) rates. Technical success was 97.4%. Early mortality was 16.3% (22% in urgent; 12% in elective; P = 0.2) and SCI and acute kidney injury were diagnosed in 13.7% (11% in urgent; 16% in elective; P = 0.2) and 18.3% (22.2% in urgent; 13.9% in elective; P = 0.18), respectively. Multivariate regression analyses showed that DAPT and b-blockers were related to lower 30-day mortality. DAPT was also preventive for SCI. Survival rates were 68.4% [standard error (SE) 0.07] at 12 months for the urgent and 75.6% (SE 0.09) at 24 months for the elective group (P = 0.14). Freedom from reintervention rates were 81.4% (SE 0.06) at 6 months and 64.7% (SE 0.09) at 18 months for the urgent and 81.7% (SE 0.06) at 6 months and 75.4% (SE 0.081) at 18 months for the elective group (P = 0.94).
CONCLUSIONS
Female patients managed with the t-Branch device for thoracoabdominal and pararenal aneurysms in elective and urgent setting presented similar 30-day mortality and SCI rates.
背景
女性的性别特征被认为是使用血管内方法治疗复杂主动脉瘤患者的死亡率增加的一个风险因素。本研究旨在介绍使用 t-Branch 装置对女性进行择期或紧急治疗的围手术期和随访结果，并研究影响早期结果的因素。
方法
这是一项在 2018 年 1 月 1 日至 2020 年 9 月 30 日期间，在两个中心进行的回顾性观察研究，包括使用 t-Branch 装置（库克医疗，比雅维森，丹麦）对胸腹部和肾周动脉瘤进行择期或紧急治疗的女性患者。主要的早期结果包括技术成功率和 30 天死亡率和发病率（脊髓缺血（SCI）和急性肾损伤）。使用 Kaplan-Meier 估计评估随访生存率和免于再次干预率。
结果
共有 153 名女性患者入选；81 名（52.9%）接受紧急治疗。紧急治疗的患者年龄更大（73.2±8.6 岁 vs. 68.5±6.8 岁；P<0.001），且之前接受过更多的经皮冠状动脉成形术/支架置入术（16.0% vs. 5.6%，P=0.005）和较低的双联抗血小板治疗（DAPT，46.3% vs. 53.7%，P=0.04）。技术成功率为 97.4%。早期死亡率为 16.3%（紧急组 22%，择期组 12%；P=0.2），SCI 和急性肾损伤的发生率分别为 13.7%（紧急组 11%，择期组 16%；P=0.2）和 18.3%（紧急组 22.2%，择期组 13.9%；P=0.18）。多变量回归分析显示，DAPT 和β受体阻滞剂与较低的 30 天死亡率相关。DAPT 也可预防 SCI。紧急组和择期组的 12 个月生存率分别为 68.4%（标准误差（SE）0.07）和 75.6%（SE 0.09）（P=0.14）。紧急组和择期组的 6 个月免于再次干预率分别为 81.4%（SE 0.06）和 81.7%（SE 0.06），18 个月免于再次干预率分别为 64.7%（SE 0.09）和 75.4%（SE 0.081）（P=0.94）。
结论
在择期和紧急情况下，使用 t-Branch 装置治疗胸腹部和肾周动脉瘤的女性患者的 30 天死亡率和 SCI 发生率相似。
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