胸主动脉覆膜支架血管腔内修复术相关逆行性A型夹层的危险因素分析  

Analysis of risk factors for retrograde type A dissection associated with thoracic endovascular aortic repair

作　　者：王国权 史帅涛 韩文豪 李晓健 王琼 牛浩 翟水亭 Wang Guoquan;Shi Shuaitao;Han Wenhao;Li Xiaojian;Wang Qiong;Niu Hao;Zhai Shuiting(Department of Vascμlar Sμrgery,Zhengzhou University People′s Hospital,Henan Provincial People′s Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院、河南省人民医院、阜外华中心血管病医院血管外科,郑州450003

出　　处：《中华放射学杂志》2023年第7期784-789,共6页Chinese Journal of Radiology

基　　金：河南省医学科技攻关项目(2018020440)。

摘　　要：目的探讨胸主动脉覆膜支架血管腔内修复术(TEVAR)相关逆行性A型夹层(RTAD)的危险因素,为临床危险分层和治疗决策提供依据。方法回顾性分析2004年1月至2019年12月在郑州大学人民医院实施TEVAR的1688例胸主动脉疾病患者临床资料,病理分类包括主动脉夹层1592例,其他胸主动脉疾病96例。通过单因素分析、分类多元logistic回归分析探讨TEVAR相关RTAD的相关危险因素。结果共发现18例RTAD,整体发生率为1.1%(18/1688),均发生于主动脉夹层患者。调整混杂因素后,分类多元logistic回归分析显示以支架放大率≤10%作为对照组,支架放大率在11%~20%时,RTAD发生率明显降低(OR=0.27,95%CI 0.07~0.96,P=0.043),差异有统计学意义;升主动脉直径以<40 mm作为对照组,≥40 mm组与对照组相比RTAD发生率(OR=2.71,95%CI 0.94~7.84,P=0.065)差异无统计学意义。结论主动脉夹层较其他胸主动脉疾病更容易发生RTAD。适当的支架放大率能够降低RTAD的发生,不建议设置过小的支架放大率。Objective To investigate the risk factors for retrograde type A dissection(RTAD)associated with thoracic endovascular aortic repair(TEVAR)which provided the basis for clinical risk stratification and treatment decision.Methods The clinical data of 1688 patients with thoracic aortic disease who underwent TEVAR in our center from January 2004 to December 2019 were retrospectively analyzed.The pathological classification included aortic dissection(1592 cases)and other thoracic aortic diseases(96 cases).Univariate analysis and categorical multiple logistic regression analysis were used to explore the risk factors for the development of RTAD during or after TEVAR.Results A total of 18 cases of RTAD were found,with an overall incidence of 1.1%(18/1688),all of which occurred in aortic dissection group.After adjusting for confounding factors,multivariate logistic regression analysis showed that the incidence of RTAD was significantly decreased(OR=0.27,95%CI 0.07-0.96,P=0.043)when the oversize of stentgraft was 11%-20%,the oversize of stentgraft was≤10%as the control group,and the difference was statistically significant(P<0.05).The ascending aorta diameter was<40 mm as the control group,and there was no significant difference in the incidence of RTAD between the≥40 mm group and the control group(OR=2.71,95%CI 0.94-7.84,P=0.065).Conclusions Aortic dissection is more likely to develop RTAD than other thoracic aortic diseases.A proper stentgraft oversizing ratio could reduce the probability of RTAD.That is to say that a too low stentgraft oversizing ratio is not recommended.

关 键 词：主动脉夹层 血管腔内修复术 逆行性A型夹层 

分 类 号：R543.1[医药卫生—心血管疾病]