Zhu Hongqiao, Zhao Kaiwen, Wang Guangkuo, Liu Junjun, Pei Yifei, Zhou Jian, Jing Zaiping
Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, 200433 Shanghai, China.
Department of Vascular Surgery, Jiangmen Central Hospital, 529020 Jiangmen, Guangdong, China.
Rev Cardiovasc Med. 2022 Jun 24;23(7):226. doi: 10.31083/j.rcm2307226. eCollection 2022 Jul.
Few studies have investigated the characteristics and long-term outcomes of type B aortic dissection (BAD) patients with simple renal cysts (SRC) after thoracic endovascular aortic repair (TEVAR).
A multi-center retrospective cohort study was performed, including 718 BAD patients undergoing TEVAR from 2003 to 2016. The prevalence of SRC was 34.5% (n = 248). After propensity score matching, 214 matched pairs were selected for further analysis. Primary outcomes were long-term aortic-related adverse events (ARAEs). The effects of SRC in each subgroup of interest and their interactions were analyzed.
BAD patients with SRC were older and had a greater prevalence of comorbidities, including hypertension, coronary artery disease and chronic occlusive pulmonary disease. In addition, the SRC group presented a greater proportion of pleural effusion and aortic calcification. Compared with the non-SRC group, a significantly higher maximal diameter of ascending aorta was observed in the SRC group. Apart from the timing of the operation, no differences were found in the medication regime or intra-operative parameters. In the matched population, patients with SRC were at a higher risk of ARAEs in the long term. The multivariable Cox model indicated that SRC was an independent predictor of long-term ARAEs (hazard ratio: 1.84, 95% confidence interval: 1.13-3.00). The interaction between SRC and hypertension on rupture after TEVAR was statistically significant ( = 0.023).
Compared with the non-SRC group, BAD patients with SRC experienced a higher risk of long-term ARAEs after TEVAR. Among the SRC subgroup, hypertensive patients had the highest risk of rupture after TEVAR.
很少有研究调查过胸主动脉腔内修复术（TEVAR）后伴有单纯肾囊肿（SRC）的B型主动脉夹层（BAD）患者的特征及长期预后。
进行了一项多中心回顾性队列研究，纳入了2003年至2016年期间接受TEVAR的718例BAD患者。SRC的患病率为34.5%（n = 248）。在进行倾向评分匹配后，选择了214对匹配对象进行进一步分析。主要结局为长期主动脉相关不良事件（ARAEs）。分析了SRC在各感兴趣亚组中的作用及其相互作用。
伴有SRC的BAD患者年龄较大，合并症患病率更高，包括高血压、冠状动脉疾病和慢性闭塞性肺疾病。此外，SRC组胸腔积液和主动脉钙化的比例更高。与非SRC组相比，SRC组升主动脉的最大直径明显更大。除手术时机外，药物治疗方案或术中参数无差异。在匹配人群中，伴有SRC的患者长期发生ARAEs的风险更高。多变量Cox模型表明，SRC是长期ARAEs的独立预测因素（风险比：1.84，95%置信区间：1.13 - 3.00）。SRC与高血压在TEVAR后破裂方面的相互作用具有统计学意义（P = 0.023）。
与非SRC组相比，伴有SRC的BAD患者在TEVAR后发生长期ARAEs的风险更高。在SRC亚组中，高血压患者在TEVAR后破裂的风险最高。
