慢性胸腹主动脉夹层的腔内治疗结果

Endovascular treatment outcomes of chronic thoracoabdominal aortic dissection

目的评估腔内治疗在治疗慢性胸腹主动脉夹层中的可行性,并分析其安全性和有效性。方法回顾性分析2021年12月至2024年3月期间在上海市第一人民医院接受全腔内治疗的慢性胸腹主动脉夹层患者,根据治疗方法将患者分为单主干组和双主干组。收集包括人口统计学特征、术前风险因素、手术细节、术后并发症和长期随访数据在内的临床资料;结局指标主要包括手术成功率、院内死亡率、内漏率及分支再狭窄发生率。结果共有34例胸腹主动脉夹层患者接受了全腔内治疗,手术成功率为100%,住院期间死亡率为2.94%,截瘫发生率为0.00%,脑梗死发生率为2.94%,Ⅲ型内漏发生率为5.88%,分支动脉狭窄发生率为8.82%,夹层进展发生率为8.82%,再干预率为14.71%。在重建内脏动脉分支方式方面单主干组以开窗支架为主,双主干组以分支支架为主,差异具有统计学意义(P<0.05);2组患者的围术期及中期随访结果差异均无统计学意义(P>0.05)。结论全腔内治疗为胸腹主动脉夹层患者提供了一个安全有效的治疗选择。

Objective To evaluate the feasibility,safety and efficacy of endovascular treatment for chronic thoracoabdominal aortic dissection.Methods The patients with chronic thoracoabdominal aortic dissection who underwent total endovascular treatment at Shanghai City First People's Hospital between December 2021 and March 2024 were retrospectively analyzed.The patients were divided into single-trunk group and double-trunk group according to the treatment methods.Clinical data including demographic characteristics,preoperative risk factors,surgical details,postoperative complications and long-term follow-up data were collected.Outcome measures mainly included surgical success rate,in-hospital mortality,endoleak rate and incidence of branch restenosis.Results Thirty-four patients with thoracoabdominal aortic dissection were treat with total endovascular treatment.That success rate of operation was 10o%.The in-hospital mortality was 2.94%.the incidence of paraplegia was 0.00%.the incidence of cerebral infarction was 2.94%.The incidence of type Il endoleak was 5.88%.The incidence of branch artery stenosis was 8.82%.The incidence of dissection progression was 8.82%.The reintervention rate was 14.71%.In the aspect of reconstruction of splanchnic artery branches,fenestration stent was the main method in the single-trunk group,and branch stent was the main method in the double-trunk group,the difference was statistically significant(P<0.05).There was no significant difference in perioperative and mid-term follow-up results between the two groups(P>0.05).Conclusion Total endovascular treatment is a safe and effective treatment option for patients with thoracoabdominal aortic dissection.