Predictors of Type 1a Endoleak After Hybrid Thoracic Endovascular Aortic Repair for Aortic Arch Diseases.

IF 3.1 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation Journal Pub Date : 2024-10-24 DOI:10.1253/circj.CJ-24-0580
Tomoaki Kudo, Toru Kuratani, Yoshiki Sawa, Shigeru Miyagawa
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Abstract

Background: This study analyzed the risk factors for type 1a endoleak after hybrid thoracic endovascular repair (TEVAR) for aortic arch diseases based on preoperative patient characteristics and multidetector computed tomography measurements.

Methods and results: In all, 213 patients who underwent proximal landing zone 1 and 2 hybrid TEVAR for aortic arch pathologies (zone 1, n=82 [38.5%]; zone 2, n=131 [61.5%]; median age 72 years) between May 2008 and February 2020 were enrolled in this study; the median follow-up period was 6.0 years. The rates of type 1a endoleak at 1, 3, 5, and 10 years were 1.4%, 1.4%, 4.1%, and 4.1%, respectively. Multivariate Cox proportional hazard regression analysis revealed that the angle of the aortic arch was a significant risk factor for type 1a endoleak (hazard ratio 1.08; 95% confidence interval 0.85-0.99; P=0.045). The estimated area under the curve in receiver operating characteristic curve analysis was 0.76, and the cut-off value of the aortic arch angle was 95°.

Conclusions: It is essential to prevent type 1a endoleak, the most severe complication of hybrid TEVAR. The risk factor for type 1a endoleak in this study was a sharper angle of the aortic arch (≤95°). For patients at high risk of type 1a endoleak, it is necessary to consider alternative procedures depending on a patient's surgical risk.

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主动脉弓疾病的混合胸腔内血管主动脉修复术后 1a 型内膜渗漏的预测因素
背景:本研究根据术前患者特征和多载体计算机断层扫描测量结果,分析了主动脉弓疾病杂交胸腔内血管修复术(TEVAR)后1a型内漏的风险因素:2008年5月至2020年2月期间,共有213名患者因主动脉弓病变接受了近端着床1区和2区杂交TEVAR手术(1区,82人[38.5%];2区,131人[61.5%];中位年龄72岁);中位随访时间为6.0年。1年、3年、5年和10年的1a型内漏发生率分别为1.4%、1.4%、4.1%和4.1%。多变量考克斯比例危险回归分析显示,主动脉弓角度是导致 1a 型内漏的重要危险因素(危险比 1.08;95% 置信区间 0.85-0.99;P=0.045)。接受者操作特征曲线分析的估计曲线下面积为0.76,主动脉弓角度的临界值为95°:结论:1a型内漏是杂交TEVAR最严重的并发症,预防1a型内漏至关重要。本研究中1a型内漏的风险因素是主动脉弓角度较大(≤95°)。对于1a型内漏的高风险患者,有必要根据患者的手术风险考虑其他手术方式。
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来源期刊
Circulation Journal
Circulation Journal 医学-心血管系统
CiteScore
5.80
自引率
12.10%
发文量
471
审稿时长
1.6 months
期刊介绍: Circulation publishes original research manuscripts, review articles, and other content related to cardiovascular health and disease, including observational studies, clinical trials, epidemiology, health services and outcomes studies, and advances in basic and translational research.
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