“两段式”覆膜支架治疗Stanford B 型主动脉夹层术后腹主动脉扩张的危险因素分析

  目的  探讨应用“两段式”覆膜支架治疗Stanford B型主动脉夹层术后腹主动脉扩张（abdominal aortic enlargement, AAE）的危险因素。  方法  回顾性分析2013年1月–2020年9月于河北北方学院附属第一医院接受“两段式”覆膜支架治疗Stanford B型主动脉夹层患者的临床及影像学资料，分别于术前、术后1周、术后3个月、术后6个月及术后每年定期随访。主要结局指标为AAE，并筛选术后AAE的相关因素，进行生存分析和多因素logistic回归分析。  结果  共完整收集146例于我院进行定期随访的患者资料，中位随访48个月（范围:12～84个月），随访期内，术后AAE发生率为19.9%（29/146），共有29例患者出现AAE（AAE组），117例未出现AAE（Non-AAE组）。随访期共有27例患者死亡（Non-AAE组13例，AAE组14例）；有10例接受了主动脉相关的再干预治疗，其中Non-AAE组4例， AAE组6例。Non-AAE组的远期生存率和免于主动脉相关的再干预率均优于AAE组（P<0.05）。多因素logistic回归分析示假腔部分血栓化〔比值比（OR）=4.090，95%可信区间（CI）:1.539～10.867，P=0.005〕、肾动脉上主动脉残留破口累积长度增加（OR=1.290，95%CI:1.164～1.429，P=0.000）及肾动脉下主动脉残留破口累积长度缩减（OR=0.487，95%CI:0.270～0.878，P=0.017）是术后AAE的独立危险因素。  结论  术后发生AAE的患者预后差。随访时应重视假腔部分血栓化、肾动脉上主动脉残留破口累积长度及肾动脉下主动脉残留破口累积长度，警惕术后AAE的发生。

Risk Factor Analysis of Abdominal Aortic Enlargement after Thoracic Endovascular Aortic Repair Using Two-Stent Graft Implantation for Stanford Type B Aortic Dissection

  Objective  To explore the risk factors of abdominal aortic enlargement (AAE) after thoracic endovascular aortic repair using two-stent graft implantation (TEVAR-TSI) for Stanford type B aortic dissection.   Methods  The clinical and imaging data of patients who underwent TEVAR-TSI for Stanford type B aortic dissection in the First Affiliated Hospital of Hebei North University from January 2013 through September 2020 were retrospectively collected and analyzed. CT angiography (CTA) scans were performed before the procedure. Follow-up CTA scans were scheduled and performed in 1, 3, 6, and 12 months after the procedure and annually thereafter. The primary outcome was AAE. The risk factors of AAE after TEVAR-TSI were selected and survival analysis and multivariate logistic regression were conducted accordingly.   Results  A total of 146 patients were regularly followed up at our hospital, with the median followup time of the entire cohort being 48 months (ranging from 12 to 84 months). During the followup period after TEVAR-TSI, the incidence of AAE was 19.9% (29/146). A total of 29 patients developed AAE (the AAE group), while 117 patients did not develop AAE (the non-AAE group). There were a total of 27 deaths, including 13 in the non-AAE group versus 14 in the AAE group. Distal aortic reoperation was performed on 10 patients, including 4 in the non-AAE group versus 6 in the AAE group. The cumulative long-term survival and freedom from distal aortic reoperation of the non-AAE group were both significantly better those of the AAE group (P<0.05). Logistic multivariate regression analysis showed that independent risk factors of AAE after TEVAR-TSI included the following, partial thrombosis of the false lumen (odds ratio OR]=4.090, 95% confidence interval CI]: 1.539-10.867, P=0.005), the longer cumulative diameter of residual intimal tear above the level of the lowest renal arteries (OR=1.290, 95% CI: 1.164-1.429, P=0.000), and shorter cumulative diameter of residual intimal tear below the level of the lowest renal arteries (OR=0.487, 95% CI: 0.270-0.878, P=0.017).   Conclusion  The prognosis of patients who developed AAE after TEVAR-TSI was not good. During followup visits, as precautions against the development of AAE, close attention should be paid to partial thrombosis of the false lumen, cumulative diameter of residual intimal tear above the level of the lowest renal arteries, and cumulative diameter of residual intimal tear below the level of the lowest renal arteries.