预开窗与外分支主动脉腔内修复术治疗主动脉病变的近期效果分析

Analysis of the short-term results of pre fenestration and external branched thoracic endovascular aortic repair for aortic lesions

目的评估应用预开窗与外分支主动脉腔内修复术(TEVAR)重建左锁骨下动脉(LSA)治疗主动脉弓降部病变的近期效果。方法回顾性分析了天津医科大学总医院2015年11月至2019年10月收治的需重建LSA的79例主动脉疾病患者的临床资料,按LSA重建方式不同分为预开窗组50例[男38例,女12例,年龄(57.3±12.5)岁]和外分支组29例[男25例,女4例,年龄(53.1±14.1)],对比分析两组患者的手术成功率、术中及术后并发症发生率、二次手术干预率、死亡率以及夹层术后的假腔重塑情况等。结果两组围手术期和近期总并发症发生率、二次干预率和死亡率等差异无统计学意义(χ^(2)=0、1.246、0.156,均P>0.05),预开窗组手术时间[(123.0±40.7)min]显著长于外分支组[(84.2±16.3)min,t=2.173,P=0.034]。两组内术后支架段假腔血栓化程度均高于非支架段(χ^(2)=7.213、14.359,均P<0.05),而两组间差异无统计学意义(χ^(2)=1.510、0.886,均P>0.05)。两组术后夹层各平面真假腔变化率差异均无统计学意义(均P>0.05)。结论预开窗与外分支TEVAR重建LSA治疗主动脉弓降部病变均具有良好的安全性和有效性。外分支TEVAR技术耗时更短,对于锚定区较短的病变具有更高的有效性,且在支架段近期主动脉重塑效果更佳;而预开窗TEVAR技术具有更好的经济性。

Objective To evaluate the short-term effect of left subclavian artery(LSA)reconstruction with pre fenestration and external branch thoracic endovascular aortic repair(TEVAR)in the treatment of aortic arch descending lesions.Methods The clinical data of 79 patients with aortic diseases who received LSA reconstruction in Tianjin Medical University General Hospital from November 2015 to October 2019 were analyzed retrospectively.According to different LSA reconstruction methods,they were divided into the fenestrated group(group f)50 cases and the external branched group(group b)29 cases.The surgical success rate,intraoperative and postoperative complication rate,re-intervention rate,mortality rate,and the change of the true and false lumen area of the dissection were compared and analyzed.Results There were no significant differences in the perioperative and recent total complication rate,secondary intervention rate and mortality between the two groups(χ^(²)=0,1.246,0.156,all P>0.05).The operation time of group f[(123.0±40.7 min)]was significantly longer than that of group b((84.2±16.3)min,t=2.173,P=0.034).The degree of false lumen thrombosis of the stent segment was better than that of the non-stent segment(χ^(²)=7.213,14.359,both P<0.05)in the two groups after surgery,but no significant difference between the two groups(χ^(²)=1.510,0.886,both P>0.05).There was no significant difference in the change rate of the true and false lumen on each plane of the dissection between the two groups(all P>0.05).Conclusions Both fenestrated and external branched TEVAR reconstruction LSA have good safety and effectiveness in treating aortic arch descending lesions.The external branched TEVAR takes less time,has higher effectiveness for lesions with shorter landing zone,and has better aortic remodeling effect in the stent segment soon;and the fenestrated TEVAR has better economy.