人工改良的开窗与分支支架治疗复杂主动脉病变术后分支相关内漏的危险因素  

Risk factors for target vessel related endoleaks after physician-modified fenestrated or branched endovascular aortic repair for complicated aortic diseases

作　　者：陈志鹏 刘昭[1] 蔡晶 李志高 苏比努尔·买买提艾力 张梦强 李晓强 乔彤[1] Chen Zhipeng;Liu Zhao;Cai Jing;Li Zhigao;Subinuer Maimaitiaili;Zhang Mengqiang;Li Xiaoqiang;Qiao Tong(Department of Vascular Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210003,China;Nanjing Drum Tower Hospital,Clinical College of Nanjing Medical University,Nanjing 210003,China)

机构地区：[1]南京大学医学院附属鼓楼医院血管外科,南京210003 [2]南京医科大学鼓楼临床医学院血管外科,南京210003

出　　处：《中华普通外科杂志》2024年第4期287-292,共6页Chinese Journal of General Surgery

摘　　要：目的分析使用人工改良的开窗与分支支架治疗复杂主动脉病变术后分支相关内漏的危险因素。方法回顾性分析2017年6月至2022年6月在本中心进行的所有开窗与分支支架手术病例的临床及随访资料。结果236例进行开窗或分支支架主动脉腔内修复术(F/BEVAR)的患者中119例被诊断为夹层动脉瘤、117例被诊断为真性动脉瘤。中位时间19个月的随访结果显示夹层动脉瘤患者较真性动脉瘤患者在F/BEVAR术后有着更高的分支支架相关内漏的发生率(18%比7%,P=0.011)。针对主动脉夹层动脉瘤患者进行进一步的分析发现21例内漏组的患者有着更大的内脏区动脉瘤直径和更多的分支血管重建数量;预制分支支架能减少分支血管相关内漏的出现;全部或部分来源于假腔的分支血管在重建后更容易出现内漏(均P<0.05)。结论主动脉夹层动脉瘤患者较真性动脉瘤患者在内脏区F/BEVAR术后更容易出现分支相关的内漏。同时,内脏区主动脉直径越大、开窗数目越多的夹层动脉瘤患者术后出现分支相关内漏的可能性更大,来源于假腔的分支血管在重建后更可能出现内漏。Objective To study the risk factors for target vessel related endoleaks in complex aortic lesions treated with physician modified fenestrated or branched endografts.Methods The clinical and follow-up data of all patients with aortic diseases treated with F/BEVAR in Drum Tower Hospital from Jun 2017 to Jun 2022 was retrospectively analyzed.All patients underwent computed tomography angiography(CTA)before and 3 months,6 months,and every year after discharge.The end points were mortality,aneurysm rupture,and emergence of and reintervention for target vessel related endoleaks.Results A total of 236 patients underwent F/BEVAR,including 119 postdissection TAAAs and 117 degenerative TAAAs.During a mean follow-up time of 19 months,patients with postdissection aneurysms have a higher incidence of branch stent related leakage after F/BEVAR surgery compared to patients with degenerative aneurysms(18%vs.7%,P=0.011).Among the 119 dissection aneurysm patients,21 patients in the endoleak group had a larger diameter of the visceral region and a greater number of branch vessel reconstructions,presewn branch stents in the fenestration position reduced the risk of target vessel-related endoleaks,target vessels derived entirely or partially from the false lumen were more prone to develop endoleaks after reconstruction(all P<0.05).Conclusions Patients with dissected aortic aneurysms are more likely to have TV-related endoleaks after F/BEVAR in the visceral region than those with degenerative aortic aneurysms.Additionally,patients with larger aortic diameters and more fenestrations in the visceral region are more likely to have TV-related endoleaks.Branch vessels deriving from the false lumen are more likely to develop endoleaks after reconstruction.

关 键 词：主动脉疾病 内漏 并发症 

分 类 号：R654.3[医药卫生—外科学]