Entry Site Is Associated With Aortic Enlargement After Pre-emptive Endovascular Repair for Uncomplicated Type B Aortic Dissection.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-10-01 Epub Date: 2023-03-16 DOI:10.1177/15266028231161224

Tomoki Cho, Keiji Uchida, Shota Yasuda, Ryo Izubuchi, Shotaro Kaneko, Atsushi Matsumoto, Makoto Ikematsu, Sho Kakuta

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引用次数: 0

Abstract

Objectives: We aimed to examine the mid-term results corresponding to the entry site in patients who underwent pre-emptive thoracic endovascular aortic aneurysm repair (TEVAR) for uncomplicated type B aortic dissection (TBAD).

Methods: We included 27 patients who underwent pre-emptive TEVAR for uncomplicated TBAD between September 2014 and December 2019. We divided the patients into 2 groups depending on the proximal landing zone (zone 2 group, zone ≥3 group) and retrospectively analyzed the risk of all-cause and aorta-related mortality, aortic events (rupture, open conversion, and secondary intervention), and aortic enlargement (≥5 mm).

Results: The median age of the patients was 53 (47-65) years. The median duration from the onset of uncomplicated TBAD to TEVAR was 43 (30-99) days, and the median follow-up duration was 48 (36-57) months. The maximum preoperative diameter of the dissected aorta was 40 mm in the zone 2 group and 35 mm in the zone ≥3 group (p=0.134). There was no case of hospital death or spinal cord ischemia; however, there was 1 (3.7%) case of perioperative stroke in the zone 2 group. Multivariate analysis of the risk factors for aortic enlargement following pre-emptive TEVAR for uncomplicated TBAD revealed that only zone 2 landing was an independent risk factor. The estimated Kaplan-Meier curve showed a higher rate of aortic enlargement in the zone 2 group at 4 years after pre-emptive TEVAR (46.4% vs 0%, log-rank test; p=0.011).

Conclusions: In this study on TBAD, we found that zone 2 landing was associated with aortic enlargement after pre-emptive TEVAR. In cases where the distance from the left subclavian artery to a major entry point was short, there were more cases of aortic dilatation.

Clinical impact: The effectiveness of entry closure for type B aortic dissection was demonstrated in the INSTEAD XL trial. The cause of aortic enlargement after pre-emptive endovascular treatment for type B aortic dissection remains controversial. In the present study, zone 2 landing was a risk factor for aortic enlargement after pre-emptive thoracic endovascular aortic aneurysm repair (TEVAR) for uncomplicated type B dissection. Patients with zone 2 landing should be closely followed up after pre-emptive TEVAR.

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无并发症 B 型主动脉夹层先期血管内修复术后，入口部位与主动脉扩大有关。

研究目的我们旨在研究因无并发症的 B 型主动脉夹层（TBAD）而接受先发制人的胸腔内血管主动脉瘤修补术（TEVAR）的患者中，与入路部位相对应的中期结果：我们纳入了2014年9月至2019年12月期间因无并发症的TBAD而接受抢先TEVAR的27例患者。我们根据近端着床区将患者分为两组（2区组、≥3区组），并回顾性分析了全因死亡率和主动脉相关死亡率、主动脉事件（破裂、开放转流和二次干预）以及主动脉扩大（≥5 mm）的风险：患者的中位年龄为 53（47-65）岁。从无并发症的 TBAD 发病到 TEVAR 的中位时间为 43（30-99）天，中位随访时间为 48（36-57）个月。2 区组和≥3 区组的术前主动脉夹层最大直径分别为 40 毫米和 35 毫米（P=0.134）。无一例住院死亡或脊髓缺血，但 2 区组有 1 例（3.7%）围术期中风。对无并发症TBAD先期TEVAR术后主动脉扩大的风险因素进行多变量分析后发现，只有2区着床是一个独立的风险因素。估计的 Kaplan-Meier 曲线显示，2 区组在先发 TEVAR 术后 4 年的主动脉扩大率更高（46.4% vs 0%，log-rank 检验；P=0.011）：在这项关于 TBAD 的研究中，我们发现 2 区着床与先发 TEVAR 后主动脉扩大有关。在左锁骨下动脉到主要入口距离较短的病例中，主动脉扩张的病例较多：临床影响：INSTEAD XL试验证明了入口闭合治疗B型主动脉夹层的有效性。B 型主动脉夹层先期血管内治疗后主动脉扩张的原因仍存在争议。在本研究中，2区着床是无并发症B型主动脉夹层先期胸腔内血管主动脉瘤修补术（TEVAR）后主动脉扩大的风险因素。在先发制人的 TEVAR 术后，应密切随访有 2 区着床的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.