Furui Masato, Matsumura Hitoshi, Hayashida Yoshio, Kuwahara Go, Fujii Mitsuru, Shimizu Masayuki, Morita Yuichi, Ito Chihaya, Hayama Masato, Wakamatsu Kayo, Wada Hideichi
Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Fukuoka, Japan.
Ann Vasc Dis. 2024 Sep 25;17(3):241-247. doi: 10.3400/avd.oa.24-00028. Epub 2024 Jun 19.
In open repair for descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA), the influence of re-interventions on spinal cord injury (SCI) remains unclear. This study evaluated the relationships between re-interventions, atherosclerosis, and SCI. We retrospectively reviewed 78 patients who underwent open surgical repair for DTAA or TAAA between April 2011 and May 2023. The associations of SCI with (i) re-interventions with a history of endovascular therapy and graft replacement and (ii) atherosclerotic factors, including monocyte count, triglyceride levels (TG), and intra-aortic plaques, were examined. The rates of SCI complications and 30-day mortality were both 3.8% (3/78). There was no significant difference between the incidence of SCI in the re-intervention and first-time intervention groups (p >0.90). However, patients with protruding plaque on computed tomography (CT) were more affected by SCI than those without (13.3% vs. 1.6%, p = 0.034). Univariate analysis revealed that SCI was associated with increased monocyte count, TG, protruding plaques on CT, and intraoperative blood loss. Re-interventions for DTAA and TAAA showed no association with the development of SCI under appropriate protective measures. The implicated risk factors may be atherosclerosis factors such as elevated monocyte count, TG, and protruding plaques on CT.
在降主动脉瘤（DTAA）或胸腹主动脉瘤（TAAA）的开放修复术中，再次干预对脊髓损伤（SCI）的影响尚不清楚。本研究评估了再次干预、动脉粥样硬化与SCI之间的关系。我们回顾性分析了2011年4月至2023年5月期间接受DTAA或TAAA开放手术修复的78例患者。研究了SCI与（i）有血管内治疗和移植物置换史的再次干预以及（ii）动脉粥样硬化因素（包括单核细胞计数、甘油三酯水平（TG）和主动脉内斑块）之间的关联。SCI并发症发生率和30天死亡率均为3.8%（3/78）。再次干预组和首次干预组的SCI发生率无显著差异（p>0.90）。然而，计算机断层扫描（CT）显示有突出斑块的患者比没有突出斑块的患者受SCI影响更大（13.3%对1.6%，p=0.034）。单因素分析显示，SCI与单核细胞计数增加、TG、CT上的突出斑块以及术中失血有关。在适当的保护措施下，DTAA和TAAA的再次干预与SCI的发生无关。可能的危险因素可能是动脉粥样硬化因素，如单核细胞计数升高、TG和CT上的突出斑块。
