探究Stanford B型主动脉夹层合并单发左侧椎动脉对胸主动脉覆膜支架修复术后结局的影响  

Exploring the impact of stanford type B aortic dissection complicated by an isolated left vertebral artery on the prognosis after thoracic endovascular aortic repair

作　　者：沈寅知 黄斌[1] 袁丁[1] 赵纪春[1] SHEN Yinzhi;HUANG Bin;YUAN Ding;ZHAO Jichun(Division of Vascular Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China Clinical Medical College,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院普通外科血管外科病房,成都610041 [2]四川大学华西临床医学院,成都610041

出　　处：《中国普外基础与临床杂志》2024年第8期961-967,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的 探究单发左侧椎动脉(isolated left vertebral artery,ILVA)的解剖变异对Stanford B型主动脉夹层(type B aortic dissection,TBAD)患者接受胸主动脉覆膜支架修复术后的临床结局和影像学结局的影响。方法 收集2016年1月至2023年12月期间于四川大学华西医院就诊的TBAD患者的临床资料,比较合并ILVA患者和未合并ILVA患者的临床结局和影像学结局事件的差别。结果 根据纳入标准,并经倾向性评分匹配后,本研究共纳入82例TBAD患者,其中合并ILVA者17例(ILVA组),未合并ILVA者65例(对照组),2组患者的影像学及手术资料比较差异均无统计学意义(P>0.05)。82例患者的中位随访时间为37个月,在随访期间,2组患者的主动脉相关死亡、主动脉事件、卒中事件、主动脉不良重塑以及ⅠA型内漏和逆撕发生率比较差异均无统计学意义(P>0.05);与对照组相比,ILVA组的再干预率[HR=2.56,95%CI为(1.55,8.11),P=0.03]和Ⅱ型内漏发生率[OR=1.36,95%CI为(1.08,2.11),P=0.04]更高。结论 合并ILVA的TBAD患者在主动脉相关死亡、逆撕等严重不良事件上与正常主动脉弓患者无明显差异,但更容易发生Ⅱ型内漏并发症,再干预率较高,需加强术后随访和复查。Objective To investigate the impact of anatomical variations of the isolated left vertebral artery(ILVA)on clinical outcomes and imaging outcomes in patients with Stanford type B aortic dissection(TBAD)who underwent thoracic endovascular aortic repair.Methods The clinical data of patients with TBAD in West China Hospital,Sichuan University from January 2016 to December 2023 were collected,and the differences of clinical outcomes and imaging outcomes between patients with and without ILVA were compared.Results Based on the inclusion criteria and the result of propensity score-based matching,82 patients with TBAD were included,including 17 patients with ILVA(ILVA group)and 65 patients without ILVA(control group).There was no significant difference between the two groups in terms of the radiological and surgical information(P>0.05).The median time of the follow-up for these 82 patients were 37 months,during which there were no significant differences in aortic-related death,aortic event,stroke,adverse aortic remodeling,typeⅠA endoleak,and retrograde progression between the two groups(P>0.05).Compared with the control group,the re-intervention rate[HR=2.56,95%CI(1.55,8.11),P=0.03]and the incidence of typeⅡinternal leakage[OR=1.36,95%CI(1.08,2.11),P=0.04]in the ILVA group were higher.Conclusions No significant differences were observed for ILVA patients in terms of serious adverse events such as aortic-related death and retrograde progression,comparing with the patients with normal aortic arch.However,the patients with ILVA were more susceptible to complications such as reintervention and typeⅡendoleak,which warranted the necessity of intensive postoperative follow-up for these patients.

关 键 词：主动脉夹层 腔内覆膜支架修复术 单发左侧椎动脉 主动脉相关死亡 主动脉不良重塑 

分 类 号：R654.3[医药卫生—外科学]