腔内修复急性Stanford B型主动脉夹层后支架远端主动脉重塑的因素分析

Analysis of factors influencing distal aortic remodeling after endovascular repair of acute Stanford B aortic dissection

目的探究急性Stanford B型主动脉夹层患者行胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)后支架远端主动脉重塑不良的影响因素。方法回顾性收集2015年1月至2020年12月于我科接受TEVAR治疗的急性Stanford B型主动脉夹层患者的临床资料,观察支架远端多平面真假腔变化情况并分析支架远端主动脉重塑不良的影响因素。结果共82例患者入组,其中58例(70.7%)患有高血压,57例(69.5%)夹层延伸至髂动脉,随访期间15例(18.3%)患者支架远端出现假腔扩大。假腔扩大组支架主体远端与主动脉角度、腹腔干上方破口数、术后剩余破口数及末次随访时Ⅰ型内漏人数均大于假腔未扩大组,假腔扩大组假腔内血栓长度则小于假腔未扩大组,以上差异具有统计学意义(均P<0.05)。多因素分析显示支架主体远端与主动脉角度过大(OR=1.282,95%CI:1.104~1.486,P=0.001)、术后仍存在较多破口(OR=3.282,95%CI:1.035~10.401,P=0.043)是TEVAR术后主动脉重塑不良的危险因素。结论支架主体远端与主动脉角度过大、术后剩余破口较多是TEVAR术后支架远端主动脉重塑不良的危险因素。

Objective To investigate the influencing factors of poor remodeling of distal aorta after thoracic endovascular repair(TEVAR)in patients with acute Stanford B aortic dissection.Methods The clinical data of patients with acute Stanford B aortic dissection who received TEVAR treatment in our department from January 2015 to December 2020 were retrospectively collected,the changes of multiplanar true and false lumens at the distal end of the stent-graft were observed,and the influencing factors of poor aortic remodeling at the distal end of the stent-graft were analyzed.Results A total of 82 patients were included,58(70.7%)of them had hypertension,57(69.5%)of them had dissection extending to the iliac artery.During the follow-up period,15(18.3%)patients had false lumen expansion at the distal end of the stent-graft.The angle between the distal end of the stent-graft and the aorta,the number of tears above the celiac trunk,the number of remaining tears after procedure and the number of type I endoleaks at the last follow-up in the false lumen expansion group were greater than those in the non-expansion group.The length of thrombus in the false lumen expansion group was smaller than that in the non-expansion group.The above differences were statistically significant(all P<0.05).Multivariate analysis showed that an excessive angle between the distal end of the stent-graft and the aorta(OR=1.282,95%CI:1.104~1.486,P=0.001),and a large number of remaining tears(OR=3.282,95%CI:1.035~10.401,P<0.043)were risk factors for poor aortic remodeling after TEVAR.Conclusions The large angle between the distal end of the stent-graft and the aorta,and the large number of residual tears are risk factors for poor remodeling of the distal aorta after TEVAR.