Stanford B型主动脉夹层患者胸主动脉腔内修复术后腹主动脉重塑的影响因素

Influencing factors of abdominal aortic remodeling in patients with Stanford type B aortic dissection after endovascular repair of thoracic aorta

目的探讨Stanford B型主动脉夹层患者胸主动脉腔内修复术(TEVAR)后腹主动脉重塑的特点及TEVAR术后发生腹主动脉扩张的影响因素。方法收集2016年1月至2020年1月于安徽医科大学附属省立医院进行诊治并接受TEVAR治疗的30例Stanford B型主动脉夹层患者的临床资料及影像学资料,将患者分为腹主动脉扩张组和腹主动脉未扩张组,每组15例。分析Stanford B型主动脉夹层患者TEVAR术后腹主动脉重塑的特点及TEVAR术后发生腹主动脉扩张的影响因素。结果腹主动脉扩张组累及腹腔干动脉、累及肠系膜上动脉、肾下腹主动脉存在大破口的患者比例均低于腹主动脉未扩张组,腹主动脉段破口数目多于腹主动脉未扩张组患者,差异均有统计学意义(P<0.05)。夹层累及腹腔干动脉、肾下腹主动脉存在大破口与腹主动脉扩张均呈负相关(r=-0.401、-0.733,P<0.05);腹主动脉段破口数目与腹主动脉扩张呈正相关(r=0.545,P<0.05)。术后计算机断层扫描血管造影(CTA)检查结果显示,腹主动脉扩张组患者的各平面假腔直径、最大径均大于腹主动脉未扩张组患者,差异均有统计学意义(P<0.05)。多因素分析结果显示,肾下腹主动脉存在大破口是Stanford B型主动脉夹层患者发生腹主动脉扩张的独立危险因素(P<0.05)。结论夹层累及腹腔干动脉、肾下腹主动脉存在大破口、腹主动脉段破口数目均与Stanford B型主动脉夹层患者TEVAR术后发生腹主动脉扩张有关,其中,肾下腹主动脉存在大破口是Stanford B型主动脉夹层患者TEVAR术后发生腹主动脉扩张的独立危险因素。

Objective To investigate the characteristics of abdominal aortic remodeling in patients with Stanford type B aortic dissection after thoracic endovascular aortic repair(TEVAR)and the influencing factors of abdominal aortic dilatation after TEVAR.Method The clinical and imaging data of 30 patients with Stanford type B aortic dissection who were diagnosed and treated in Provincial Hospital Affiliated to Anhui Medical University from January 2016 to January 2020 and received TEVAR treatment were collected.According to whether the abdominal aorta was dilated,the patients were divided into the abdominal aorta dilated group and the abdominal aorta not dilated group,with 15 patients in each group.Result The proportion of patients with large breach involving celiac trunk artery,superior mesenteric artery and infrarenal abdominal aorta in the abdominal aortic dilatation group was lower than that in the abdominal aortic non dilatation group,and the number of abdominal aortic segment breach was more than that in the abdominal aortic non dilatation group,the difference was statistically significant(P<0.05).Correlation analysis showed that dissection involving the celiac trunk and infrarenal abdominal aorta large breach were negatively correlated with abdominal aortic dilatation(r=-0.401,-0.733,P<0.05);the number of abdominal aortic segment breaks was positively correlated with abdominal aortic dilatation(r=0.545,P<0.05).The results of postoperative computed tomography angiography(CTA)showed that the diameter and maximum diameter of each plane of false lumen in patients with abdominal aortic dilatation were greater than those in patients without abdominal aortic dilatation(P<0.05).The results of multivariate analysis showed that the large infrarenal aortic break was an independent risk factor for abdominal aortic dilatation in patients with Stanford type B aortic dissection(P<0.05).Conclusion The dissection involving the celiac trunk,the presence of a large breach and number of abdominal aortic segment breaks involved by dissection are related to abdominal aortic dilatation after TEVAR in patients with Stanford type B aortic dissection.Among them,infrarenal abdominal aorta large breach is an independent risk factor for abdominal active pulse dilatation after TEVAR in patients with Stanford type B aortic dissection.