摘要
目的探究Stanford B型主动脉夹层TEVAR术后再干预情况及相关危险因素。方法回顾性分析2014年1月至2018年1月新疆医科大学第二附属医院初次行TEVAR的Stanford B型主动脉夹层患者93例,对再干预组和无需再干预的对照组进行比较,分析影响患者TEVAR术后再干预的危险因素。结果22例患者(23.7%)进行再干预,包括内漏5例,再发夹层6例,假腔不完全血栓化5例,新发动脉瘤3例,夹层逆撕3例。多因素Logistc回归分析显示,慢性期进行手术(OR=1.921,95%CI=1.186~3.112)、直筒型移植物(OR=1.754,95%CI=1.144~2.689)、移植物长度≤145 mm(OR=2.186,95%CI=1.681~2.842)、术后假腔扩张直径>5 mm(OR=1.976,95%CI=1.276~3.059)、移植物放大率>15%(OR=2.040,95%CI=1.100~3.783)是TEVAR术后再干预的独立危险因素。结论手术时机、移植物选择和对假腔扩张的影响、术后远端破口的存在是TEVAR术后再行手术干预的相关因素,应选择适宜的手术时机及移植物,避免再干预。
Objective To explore the risk factors of re-intervention after TEVAR for Stanford type B aortic dissection(TBAD).Methods The clinical data of 93 patients with TBAD who underwent TEVAR for the first time in the Second Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2018 were analyzed retrospectively.We compared the re-intervention group and the control group who were without re-intervention,and analyzed the risk factors of re-intervention after TEVAR.Results 22 patients(23.7%)received re-intervention,including 5 cases with endoleak,6 cases with recurrent dissection,5 cases with incomplete pseudocoel thrombosis,3 cases with new aneurysm and 3 cases with reverse dissection.Multivariate Logistc regression analysis showed that surgery in the chronic phase(OR=1.921,95%CI=1.186~3.112),straight-tube grafts(OR=1.754,95%CI=1.144~2.689),graft length≤145 mm(OR=2.186,95%CI=1.681~2.842),postoperative false cavity expansion diameter>5 mm(OR=1.976,95%CI=1.276~3.059)and graft magnification>15%(OR=2.040,95%CI=1.100~3.783)were the independent risk factors of re-intervention after TEVAR.Conclusion The operation timing,choice of graft sand its effects on pseudocoele expansion and postoperative distal rupture are the risk factors of re-intervention after TEVAR.We should be selected the appropriate timing of surgery and grafts to avoid re-intervention.
作者
彭栋
阿拉法特·艾尔肯
沙尔娜
Peng Dong;Arafat Elken;Sarna(Department of Interventional Therapy,the Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830063,China)
出处
《中国血管外科杂志（电子版）》
2021年第1期17-20,共4页
Chinese Journal of Vascular Surgery(Electronic Version)
关键词
主动脉夹层
胸主动脉腔内修复术
再干预
危险因素
Aortic dissection
Thoracic endovascular aortic repair
Re-intervention
Risk factors
