急性Stanford B 型主动脉夹层腔内修复术后远端主动脉负性重塑危险因素分析

Risk Factors for Adverse Aortic Remodeling in Post-TEVAR Patients with Acute Stanford B Aortic Dissection

目的应用计算机断层扫描及影像分析软件评估Stanford B型主动脉夹层胸主动脉腔内修复术(thoracic endovascular aortic repair, TEVAR)后支架远端主动脉形态学变化,探讨术后发生支架远端主动脉负性重塑的危险因素。方法回顾性分析2005年10月至2015年12月于我院接受TEVAR手术的急性Stanford B型主动脉夹层患者的临床资料和影像学数据,结合既往Criadol分区原则将主动脉归纳分为胸降主动脉区、肾上腹主动脉区、肾下腹主动脉区及髂动脉区,评估不同区域主动脉真假腔形态及破口分布情况。利用单因素和多元logistic回归分析发生支架远端主动脉负性重塑的危险因素。结果共完整收集216例于我院进行定期随访的患者资料,平均随访(3.9±2.1)年,随访期内47例(21.8%)患者支架远端主动脉出现负性重塑。单因素logistic线性回归分析发现主动脉壁结构异常(马凡综合征病史)和假腔持续通畅(远端破口存在、假腔血栓化不全)是本组患者TEVAR术后支架远端主动脉负性重塑的危险因素;多元logistic回归分析显示,胸降主动脉区破口多[比值比(OR)=1.36, 95%可信区间(CI):1.12-1.58,P=0.005)]以及肾下腹主动脉区破口少(OR=0.49, 95%CI:0.22-0.71,P<0.001)是患者术后支架远端主动脉负性重塑的独立危险因素。结论主动脉壁结构异常、假腔持续通畅、胸降主动脉区破口多及肾下腹主动脉区破口少是急性Stanford B型主动脉夹层患者TEVAR术后支架远端主动脉负性重塑的独立危险因素。

Objective To assess morphological changes of distal aorta and the risk factors for adverse aortic remodeling inpost-TEVAR(thoracic endovascular aortic repair) patients with acute Stanford B aortic dissection. Methods We retrospectively investigated the patients who underwent TEVAR for a type B dissection between October 2005 and December 2015. CT angiogram(CTA) was obtained for each patients preoperatively, postoperatively and during the post-operational follow-up. Based on Criadol partition principle, we divided the aorta into descending thoracic aorta area, suprarenal abdominal aorta area, infrarenal abdominal aorta area and iliac artery area, and evaluated the distribution of aortic tears and the form of true and false lumen in different aortic partition. Univariate and multivariate logistic regression analyses were used to analyze the risk factors affecting distal aortic remodeling.Results Of 216 patients [mean follow-up(3.9±2.1) years] who were regularly followed up in our center, 47 patients(21.8%) occurred adverse remodeling in distal aorta. Univariate logistic regression indicated that abnormal aortic wall structure(Marfan’s syndrome) and patent false lumen(existence of distal tears, decreased complete false lumen thrombosis) were associated with distal aortic adverse remodeling. Multivariate logistic regression showed that more tears in descending thoracic aorta area(OR=1.36, 95%CI:1.12-1.58, P=0.005) and less tears in infrarenal abdominal aorta area(OR=0.49, 95%CI:0.22-0.71, P<0.001) were independent risk factors affecting remodeling in distal aorta after TEVAR. Conclusion Aortic wall structure abnormalities, a patent false lumen, more tears in descending thoracic aorta area, less tears in infrarenal abdominal aorta area are independent risk factors for adverse aortic remodeling in post-TEVAR patients with acute Stanford B aortic dissection.