“原发性主动脉”（动脉瘤、主动脉夹层、穿透性主动脉溃疡）和“继发性主动脉”（医源性、创伤性、主动脉食管瘘）紧急腔内血管修复术（TEVAR）适应证的单中心回顾性亚组分析
Single-Center Retrospective Subgroup Analysis of "Primary Aortic" (Aneurysm, Aortic Dissection, PAU) and "Secondary Aortic" (Iatrogenic, Trauma, Aortoesophageal Fistula) Indications for Emergency TEVAR.
作者信息
Rebelo Artur, Partsakhashvili Jumber, Ronellenfitsch Ulrich, John Endres, Kleeff Jörg, Ukkat Jörg
机构信息
Department of General, Abdominal, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany.
出版信息
J Clin Med. 2023 Jun 13;12(12):4037. doi: 10.3390/jcm12124037.
BACKGROUND
The aim of this study was to analyze the outcome of emergency thoracic endovascular aortic repair (TEVAR) in the treatment of "primary aortic" (aneurysm, aortic dissection, penetrating aortic ulcer (PAU)) and "secondary aortic" (iatrogenic, trauma, and aortoesophageal fistula) pathologies.
METHODS
Retrospective review of a cohort of patients treated at a single tertiary referral center from 2015 to 2021. The primary end point was postoperative in-hospital mortality. Secondary end points were the duration of the procedure, duration of postoperative intensive care treatment, length of hospital stay, and the nature and severity of postoperative complications according to the Dindo-Clavien classification.
RESULTS
A total of 34 patients underwent TEVAR for emergency indications. Twenty-two patients were treated for primary and twelve patients for secondary aortic pathologies. Concerning in-hospital mortality, no statistically significant difference could be observed between the primary and secondary aortic groups (27.3% vs. 33.3%, = 0.711). Patients with an aortoesophageal fistula had a mortality rate of 66.7%. Postoperative morbidity (Dindo-Clavien > 3) was also not statistically significantly different between the primary and secondary aortic groups (36.4% vs. 33.3%, = 0.86). Preoperative hemoglobin level ( < 0.001 for mortality, = 0.002 for morbidity), hemoglobin level difference ( = 0.022, = 0.032), postoperative creatinine level ( = 0.009, = 0.035), and pre- and postoperative lactate levels ( < 0.001 for both mortality and morbidity) were found to be independent factors associated with postoperative mortality and morbidity (Dindo-Clavien > 3), respectively. The preoperative creatinine level was found to be associated with mortality ( = 0.024) but not morbidity.
CONCLUSIONS
Morbidity and in-hospital mortality are still considerable after emergency TEVAR for both primary and secondary aortic indications. Pre- and postoperative levels of hemoglobin, creatinine, and lactate may be valuable to predict patient outcomes.
背景
本研究旨在分析急诊胸主动脉腔内修复术（TEVAR）治疗“原发性主动脉”（动脉瘤、主动脉夹层、穿透性主动脉溃疡（PAU））和“继发性主动脉”（医源性、创伤性和主动脉食管瘘）病变的疗效。
方法
回顾性分析2015年至2021年在单一三级转诊中心接受治疗的一组患者。主要终点是术后住院死亡率。次要终点是手术持续时间、术后重症监护治疗持续时间、住院时间，以及根据Dindo-Clavien分类法划分的术后并发症的性质和严重程度。
结果
共有34例患者因急诊指征接受了TEVAR治疗。22例患者治疗原发性主动脉病变，12例患者治疗继发性主动脉病变。关于住院死亡率，原发性和继发性主动脉病变组之间未观察到统计学上的显著差异（27.3%对33.3%，P = 0.711）。主动脉食管瘘患者的死亡率为66.7%。原发性和继发性主动脉病变组之间的术后发病率（Dindo-Clavien > 3）也无统计学显著差异（36.4%对33.3%，P = 0.86）。术前血红蛋白水平（死亡率P < 0.001，发病率P = 0.002）、血红蛋白水平差异（P = 0.022，P = 0.032）、术后肌酐水平（P = 0.009，P = 0.035）以及术前和术后乳酸水平（死亡率和发病率P均 < 0.001）分别被发现是与术后死亡率和发病率（Dindo-Clavien > 3）相关的独立因素。术前肌酐水平被发现与死亡率相关（P = 0.024），但与发病率无关。
结论
对于原发性和继发性主动脉指征，急诊TEVAR术后的发病率和住院死亡率仍然相当高。术前和术后的血红蛋白、肌酐和乳酸水平可能对预测患者预后有价值。
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