结缔组织疾病患者的血管内弓和胸腹主动脉介入治疗:一个跨越17年的病例系列

IF 1.6 Q2 SURGERY
Griffin P Stinson, Carlos A Valdes, Ahmet Bilgili, Liam Kugler, Fabian Jimenez Contreras, Christopher Bobba, Matthew Purlee, Suzannah Patterson, T Everett Jones, Zain Shahid, Thomas M Beaver, Salvatore Scali, John R Spratt
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引用次数: 0

摘要

目的:与血管内介入治疗相比,开放式主动脉修复术被认为是结缔组织疾病(CTD)患者的标准治疗方法。然而,一些复杂的CTD患者表现增加了开放修复的风险,倾向于血管内介入治疗。本分析旨在回顾我们对CTD患者进行血管内介入治疗的经验,并确定这种方法可以合理考虑的情况。方法:回顾性分析我院2006年至2023年行血管内介入治疗的CTD患者。主要结局是无主动脉相关死亡。次要结局包括全因死亡率和免于二次干预。结果:45例CTD患者行血管内介入治疗。35例患者(77.8%)既往至少有1次主动脉介入治疗。紧急或紧急表现是常见的(n = 31, 68.8%)。在指数住院时,32例(71.1%)患者接受了胸腔血管内主动脉修复,6例(13.3%)患者接受了开窗和/或分支血管内修复。动脉瘤(40例,88.9%)和夹层(36例,80.0%)是最常见的适应症;许多患者(n = 31, 68.9%)同时出现这两种症状。1年和3年主动脉相关死亡率分别为88.7%±5%和83.2%±6%。没有临床或手术因素可预测主动脉相关死亡率。21例(46.7%)患者需要二次干预;到二次干预的中位时间为6.5个月(6.5个月,18.9个月)。1年和3年的二次干预自由度分别为60.0%±8%和51.4%±9%。结论:对于最初不适合开放修复的CTD患者,血管内介入通常可以挽救生命。主动脉相关死亡率较低,在研究期间,只有不到一半的患者需要二次干预。这说明了血管内介入治疗在CTD患者最终开放修复中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Endovascular Arch and Thoracoabdominal Aortic Intervention in Patients With Connective Tissue Diseases: A Case Series Spanning 17 Years.

Objective: Open aortic repair is considered the standard of care for patients with connective tissue disease (CTD) due to the perceived durability advantages compared with endovascular intervention. However, some complex CTD patient presentations increase risk with open repair, favoring endovascular intervention. This analysis sought to review our experience with endovascular intervention in CTD patients and identify scenarios in which this approach may reasonably be considered.

Methods: Patients with CTD undergoing endovascular intervention at our institution from 2006 to 2023 were retrospectively reviewed. The primary outcome was freedom from aorta-related mortality. Secondary outcomes included all-cause mortality and freedom from secondary intervention.

Results: Forty-five CTD patients underwent endovascular intervention. Thirty-five patients (77.8%) had at least 1 previous aortic intervention. Urgent or emergent presentation was common (n = 31, 68.8%). At index hospitalization, 32 patients (71.1%) underwent thoracic endovascular aortic repair, and 6 patients (13.3%) underwent fenestrated and/or branched endovascular repair. Aneurysm (n = 40, 88.9%) and dissection (n = 36, 80.0%) were the most common indications; many patients (n = 31, 68.9%) presented with both. Freedom from aorta-related mortality was 88.7% ± 5% and 83.2% ± 6% at 1 and 3 years, respectively. No clinical or procedural factors were predictive of aorta-related mortality. Twenty-one patients (46.7%) required secondary intervention; the median time to secondary intervention was 6.5 months (6.5, 18.9 months). Freedom from secondary intervention was 60.0% ± 8% and 51.4% ± 9% at 1 and 3 years, respectively.

Conclusions: Endovascular intervention is often lifesaving in CTD patients who are not initially candidates for open repair. Aorta-related mortality was low, and fewer than half of patients required secondary intervention during the study period. This illustrates the utility of endovascular intervention in bridging CTD patients to definitive open repair.

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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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