开窗-分支胸主动脉腔内修复术治疗主动脉弓部病变术后并发症危险因素的多中心回顾性研究

Risk factors of postoperative complications after fenestrated/branched TEVAR for aortic arch lesions:a multicenter retrospective analysis

目的总结开窗-分支胸主动脉腔内修复术(F/B-TEVAR)治疗复杂主动脉弓疾病患者并发症的危险因素。方法回顾性分析2019年2月至2023年9月多中心接受F/B-TEVAR修复主动脉弓部病变的202例患者的临床及随访资料。结果202例患者术后出现并发症46例(22.8%)。分析显示风险因素包括:主动脉粥样硬化斑块[OR=2.843;95%CI(1.4~5.6);P<0.01]、主动脉壁内血栓[OR=2.358;95%CI(1.2~4.6);P=0.011]、主动脉扩张[OR=4.219;95%CI(1.6~11.3);P<0.01]、脑卒中史[OR=2.088;95%CI(1.1~4.1);P=0.032]、吸烟史[OR=2.680;95%CI(1.3~5.5);P<0.01]、手术时长[OR=1.9;95%CI(1.2~2.9);P=0.042]。3D打印辅助技术应用[OR=0.392;95%CI(0.2~0.9);P=0.048]可以降低并发症发生率。结论主动脉粥样硬化斑块、主动脉壁内血栓、主动脉扩张、脑卒中史、吸烟史、手术时长是F/B-TEVAR术后发生并发症的独立危险因素,应用3D打印技术辅助能降低并发症发生率。

Objective To review the risk factors for early and medium-term complications of fenestration-branch endovascular thoracic aortic repair(F/B-TEVAR)in patients with complex aortic arch disease.Methods The clinical and follow-up data of 202 patients undergoing F/B-TEVAR treatment from Feb 2019 to Sep 2023 in these centers were retrospectively analyzed.Results There were 46 cases suffering from postoperative complications(22.8%).The risk factors with statistical significance included aortic atherosclerotic plaque[OR=2.843;95%CI(1.4-5.6);P<0.01],aortic intramural thrombosis[OR=2.358;95%CI(1.2-4.6),P=0.011],the aortic dilatation[OR=4.219;95%CI(1.6-11.3),P<0.01],the history of stroke[OR=2.088;95%CI(1.1-4.1),P=0.032],smoking history[OR=2.680;95%CI:(1.3-5.5);P<0.01],duration of surgery[OR=1.9;95%CI:(1.2-2.9);P=0.042].While the application of 3D printing assistive technology[OR=0.392;95%CI:(0.2-0.9);P=0.048]was in a negative correlation with postoperative complication.Conclusions The independent risk factors for complications after F/B-TVAR included aortic atherosclerotic plaque,aortic intramural thrombosis,the aortic dilatation,the history of stroke,smoking history,duration of surgery.The application of 3D printing technology can effectively reduce the complication rate.