亚急性期Stanford B型主动脉夹层腔内隔绝术后主动脉重塑的特点及影响因素

Features of aortic remodeling in Stanford type B subacute aortic dissection after thoracic endovascular aortic repair and the influential factors

目的:探讨亚急性期Stanford B型主动脉夹层胸主动脉腔内修复术(TEVAR)后的血管重塑特点及影响因素。方法:回顾性分析2008年1月—2016年6月于安徽省立医院血管外科行TEVAR的50例亚急性期Stanford B型主动脉夹层患者术前及术后临床及影像学资料,分析术后3、6、12个月主动脉各平面段真假腔直径及假腔血栓化情况及术后主动脉重塑的影响因素。结果:TEVAR手术技术成功率为100%。术后8例失访。其余42例患者的影像学资料分析结果显示,TEVAR术后各时间点胸主动脉段真腔直径较术前明显扩大、假腔直径较术前明显缩小(均P<0.05),而腹主动脉段真腔和假腔变化与术前均无统计学差异(均P>0.05);胸主动脉段术后假腔血栓化比率高于腹主动脉。多因素分析显示,假腔内存在分支血管灌注(OR=27.45,P<0.05)、存在多破口(OR=19.02,P<0.05)是TEVAR术后主动脉重塑不良的独立危险因素。结论:亚急性期Stanford B型主动脉夹层行TEVAR后胸主动脉段重塑优于腹主动脉段;假腔内存在分支血管灌注、存在多破口是TEVAR术后主动脉重塑不良的独立危险因素。

Objective： To investigate the features of aortic remodeling in Stanford type B subacute aortic dissection after thoracic endovascular aortic repair （TEVAR） and the influential factors. Methods： The pre- and postoperative clinical and imaging data of 50 patients with Stanford type B sub-acute aortic dissection undergoing TEVAR in Department of Vascular Surgery of Anhui Provincial Hospital from January 2008 to June 2016 were retrospectively analyzed. The changes in the true lumen and false lumen of diffierent segments of the aorta at postoperative 3, 6 and 12 months after TEVAR as well as the influential factors for postoperative aortic remodeling were analyzed. Results： The technical success rate of TEVAR was 100%. Eight patients were lost to follow-up after operation. The imaging data of the remaining 42 patients showed that at each time point after TEVAR, true lumen diameter was significantly increased and the false lumen diameter was significantly decreased compared with their preoperative values in the segment of the thoracic aorta （all P〈0.05）, while no significant changes were observed in both true lumen and false lumen of the abdominal aortic segment compared with their preoperative values （allP〉0.05）; the complete false lumen thrombosis rate of the thoracic aorta was higher than that of the abdominal aorta. Multivariate analysis showed that branches perfused from the false lumen （OR=27.45,P〈0.05） and the presence of multiple tears （OR=19.02,P〈0.05） were independent risk factors for adverse aortic remodeling in Stanford type B subacute aortic dissection after TEVAR. Conclusion： The aortic remodeling in the thoracic aorta is better than that in the abdominal aortic segment. The branches perfused from the false lumen and presence of multiple tears are independent risk factors for adverse aortic remodeling after TEVAR.