摘要
目的 分析复杂胸腹主动脉疾病患者行开窗或分支支架技术(F/B-EVAR)治疗后并发症的危险因素.方法 回顾性分析2021-2023年在南京大学医学院附属鼓楼医院血管外科接受F/B-EVAR治疗的147例胸腹主动脉疾病患者的临床资料.采用多变量相关性分析探讨中期随访患者术后并发症的危险因素.结果 术后死亡13例,病死率为8.8％;发生手术相关并发症52例,发生率为35.4％;术后内漏31例,内漏率为21.1％;分支支架相关内漏14例,共涉及14个分支;分支闭塞4例,共涉及5个分支.本研究再干预率为20.4％(30/147),术后肾功能不全20例(13.6％),1例患者术后因脊髓缺血出现截瘫,术后支架感染1例.对患者术后死亡、总并发症、内漏、术后肾衰竭进行危险因素分析,总并发症危险因素包括术前肾功能不全、主动脉疾病、主动脉扭曲角度＞60 °、平均分支重建数;术后出现内漏的独立影响因素包括性别、年龄、既往肾功能不全史、既往胸主动脉腔内修复术(TEVAR)史、主动脉扭曲角度＞60 °、胸腹主动脉夹层(TAAD)真腔直径;术后肾衰竭的独立影响因素为术前肾功能不全.结论 女性、年龄、胸腹主动脉瘤(TAAA)、既往肾功能不全史、既往TEVAR史、主动脉扭曲角度＞60 °、TAAD真腔直径是复杂胸腹主动脉疾病患者术后并发症的影响因素,可能相关因素是TAAA瘤腔直径、TAAD假腔直径.
Abstract
Objective To analyze the risk factors of occurrence of complications after fenestrated or branched endovascular aortic repair(F/B-EVAR)for complex thoracoabdominal aortic diseases.Meth-ods Clinical materials of 147 patients with F/B-EVAR for thoracoabdominal aortic diseases in the Department of Vascular Surgery of Drum Tower Hospital Affiliated to Medical College of Nanjing Uni-versity from 2021 to 2023 were retrospectively analyzed.Multivariate correlation analysis was used to explore the risk factors for postoperative complications during the mid-term follow-up.Results There were 13 postoperative deaths,with a mortality rate of 8.8％;52 patients experienced overall surgery-related complications,with an incidence rate of 35.4％;31 patients had postoperative endoleaks,with an endoleak rate of 21.1％;14 patients had branch stent-related endoleaks,involving 14 bran-ches;and 4 patients had branch occlusion,involving 5 branches.The re-intervention rate in this study was 20.4％(30/147),with 20 cases(13.6％)of postoperative renal insufficiency and 1 case of postoperative paraplegia due to spinal cord ischemia,as well as 1 case of postoperative stent infec-tion.Risk factor analysis for postoperative mortality,overall complications,endoleaks,and postoper-ative renal failure was conducted,and the risk factors for overall complications included preoperative renal insufficiency,aortic disease,aortic tortuosity angle＞60 °,and average number of branch re-constructions.The independent influencing factors for postoperative endoleaks included gender,age,history of renal insufficiency,history of thoracic endovascular aortic repair(TEVAR),aortic tortuosity angle＞60°,and true lumen diameter in thoracoabdominal aortic dissection(TAAD).The inde-pendent influencing factor for postoperative renal failure was preoperative renal insufficiency.Con-clusion Female,age,thoracoabdominal aortic aneurysm(TAAA),history of renal insufficiency,history of TEVAR,aortic tortuosity angle＞60°,and true lumen diameter in TAAD are the influen-cing factors for postoperative complications in patients with thoracoabdominal aortic diseases,and the possible related factors are TAAA sac diameter and TAAD false lumen diameter.
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