Debakey Ⅲb型主动脉夹层腔内修复术后腹主动脉重塑的影响因素分析

南昌大学第二附属医院 血管外科,江西 南昌 330000




Analysis of factors for abdominal aortic remodeling after endovascular repair of Debakey type Ⅲb aortic dissection

Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang 330000, China

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    背景与目的 胸主动脉腔内修复术(TEVAR)是复杂型主动脉夹层的首选治疗方法,近年来已得到广泛应用。TEVAR通常只封闭原发破口,而对夹层远端破口采取旷置处理,但在长期随访中发现旷置远端破口可导致一系列并发症,包括支架远端瘤样扩张、灌注不良导致内脏缺血及覆膜支架远端新发夹层等。此外,近期研究发现TEVAR术后支架覆盖段的胸主动脉重塑效果较好,但对于支架未覆盖的腹主动脉段重塑效果却不尽如人意,甚至出现主动脉扩张或形成夹层动脉瘤,需要再次干预。鉴于TEVAR术后腹主动脉重塑不良与患者预后密切相关,本研究探讨急性期、亚急性期Debakey Ⅲb型主动脉夹层患者TEVAR术后腹主动脉重塑情况及潜在的影响因素,为临床提供参考。方法 回顾性收集2017年5月—2023年5月南昌大学第二附属医院血管外科行TEVAR的Debakey Ⅲb型主动脉夹层患者术前、术后1年的临床信息及影像学资料,根据患者腹主动脉最大直径平面的动脉直径和真、假腔变化将患者分为未重塑组和重塑组,分析TEVAR术后腹主动脉重塑的影响因素。结果 根据纳入与排除标准,最终入选105例患者,其中未重塑组44例,重塑组61例。单因素分析结果显示,两组患者在性别、手术距发病时间、既往史等方面差异均无统计学意义(均P>0.05);未重塑组与重塑组在中位年龄(62.50岁 vs. 55.00岁)、平均远端破口数量(2.98个 vs. 2.26个)、累及左肾动脉比例(38.64% vs. 19.67%)方面差异有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,远端破口数量是影响TEVAR术后腹主动脉重塑的独立危险因素(OR=0.589,95% CI=0.406~0.855,P=0.005)。结论 TEVAR术后部分患者腹主动脉重塑不良,远端破口数量是影响腹主动脉重塑的主要因素。对于远端破口较多者,应密切随访观察患者的主动脉重塑情况,必要时再次手术干预。


    Background and Aims Thoracic endovascular aortic repair (TEVAR) has become the preferred treatment for complex aortic dissections and has been widely applied in recent years. TEVAR usually needs to cover the primary tear alone, leaving the distal tear uncovered. However, long-term follow-up has revealed that leaving the distal tear untreated can lead to a series of complications, such as aneurysmal dilatation at the distal end of stent-graft, inadequate perfusion causing visceral ischemia, and the development of new dissections at the distal end of the covered stent. Additionally, recent studies have demonstrated that the remodeling effect in the thoracic aortic segment with stent coverage is favorable after TEVAR, but the remodeling effect in the abdominal aortic segment without stent coverage is less satisfactory, potentially leading to aortic dilation or the development of dissecting aneurysms, requiring further intervention. Given the close relationship between poor abdominal aortic remodeling after TEVAR and the prognosis of patients, this study was performed to investigate the abdominal aortic remodeling following TEVAR in patients with acute or subacute Debakey IIIb aortic dissection and the potential influencing factor, so as to provide a reference for clinical practice.Methods The preoperative and one-year postoperative information as well as imaging data of patients with Debakey IIIb aortic dissection undergoing TEVAR surgery in the Second Affiliated Hospital of Nanchang University from May 2017 to May 2023 were retrospectively collected. Patients were categorized into non-remodeling and remodeling groups according to the arterial diameter of the maximum diameter plane of the abdominal aorta and the changes in the true and false lumens. Factors influencing abdominal aortic remodeling after TEVAR were analyzed.Results Based on inclusion and exclusion criteria, 105 patients were finally selected, with 44 in the non-remodeling group and 61 in the remodeling group. Results of univariate analysis showed that there were no statistically significant differences between the two groups in terms of sex, time from symptom onset to surgery, and medical history (all P>0.05); there were significant differences between the non-remodeling and remodeling groups in terms of median age (62.50 years vs. 55.00 years), average number of the distal tears (2.98 vs. 2.26), and the proportion of cases with left renal artery involvement (38.64% vs. 19.67%) (all P<0.05). Results of Multivariate Logistic regression analysis revealed that the number of distal tears was an independent risk factor for abdominal aortic remodeling after TEVAR (OR=0.589, 95% CI=0.406~0.855, P=0.005).Conclusion Following TEVAR, some patients exhibit inadequate remodeling of the abdominal aorta, and the primary factor influencing this is the number of distal tears. For those with a higher number of distal tears, close follow-up and observation of aortic remodeling are recommended, and surgical intervention may be necessary if needed.


吕凡振,翁翔,张滕,李先贵,赵文鹏,章文文,周为民. Debakey Ⅲb型主动脉夹层腔内修复术后腹主动脉重塑的影响因素分析[J].中国普通外科杂志,2023,32(12):1901-1907.
DOI:10.7659/j. issn.1005-6947.2023.12.009

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  • 收稿日期:2023-11-08
  • 最后修改日期:2023-12-06
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  • 在线发布日期: 2024-01-09