{"title":"分支式和瓣膜式主动脉弓修复术疗效的性别比较分析","authors":"","doi":"10.1016/j.ejvs.2024.04.030","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>Female sex is a risk factor for adverse events after endovascular aortic repair. Sex comparative early and midterm outcomes of fenestrated and branched endovascular aortic arch repair (F/B-Arch) are presented.</p></div><div><h3>Methods</h3><p>A single centre retrospective sex comparative analysis of consecutive patients managed with F/B-Arch was conducted according to STROBE. Primary outcomes were sex comparative technical success, death, and cerebrovascular morbidity at 30 days. Kaplan–Meier estimates were used for follow up outcomes.</p></div><div><h3>Results</h3><p>Among 209 patients, 38.3% were women. Coronary artery disease (<em>p</em> < .001) and previous myocardial infarction (<em>p</em> = .01) were more common in women. Non-native proximal aortic landing was higher in women (women: 51.3%; men: 31.8%, <em>p</em> = .005) and the aortic dissection rate was lower (28.8% <em>vs</em>. 48.1%, <em>p</em> = .005). Proximal landing to Ishimaru zones showed no difference (zone 0: <em>p</em> = .18; zone 1: <em>p</em> = .47; zone 2: <em>p</em> = .39). Graft configurations were equally distributed. In total, 416 supra-aortic trunks were bridged. The median number of revascularisations per patient was two (interquartile range 1, 3), with no difference between sexes (<em>p</em> = .54). Technical success (women: 97.5%; men: 96.9%, <em>p</em> = .80), 30 day mortality rate (women: 10%; men: 9.3%, <em>p</em> = .86), and cerebrovascular morbidity (women: 11.3%; men: 17.1%, <em>p</em> = .25) were similar. Women presented more access related complications (women: 32.5%; men: 16.3%, <em>p</em> = .006), without affecting access related re-interventions (<em>p</em> = .55). Survival (women: 81.1%, 95% confidence interval [CI] 76.3 – 85.9%; men: 79.8%, 95% CI 76.0 – 83.6%) and freedom from re-intervention (women: 56.6%, 95% CI 50.4 – 62.8%; men: 55.3%, 95% CI 50.1 – 60.5%) at 12 months were similar (log rank, <em>p</em> = .40 and <em>p</em> = .41, respectively).</p></div><div><h3>Conclusion</h3><p>Both sexes presented similar outcomes after F/B-Arch. Appropriate patient selection may decrease the effect of sex in F/B-Arch outcomes.</p></div>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1078588424003666/pdfft?md5=e53d8e003a79884735a65e11bba7f41d&pid=1-s2.0-S1078588424003666-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Sex Comparative Analysis of Branched and Fenestrated Endovascular Aortic Arch Repair Outcomes\",\"authors\":\"\",\"doi\":\"10.1016/j.ejvs.2024.04.030\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>Female sex is a risk factor for adverse events after endovascular aortic repair. Sex comparative early and midterm outcomes of fenestrated and branched endovascular aortic arch repair (F/B-Arch) are presented.</p></div><div><h3>Methods</h3><p>A single centre retrospective sex comparative analysis of consecutive patients managed with F/B-Arch was conducted according to STROBE. Primary outcomes were sex comparative technical success, death, and cerebrovascular morbidity at 30 days. Kaplan–Meier estimates were used for follow up outcomes.</p></div><div><h3>Results</h3><p>Among 209 patients, 38.3% were women. Coronary artery disease (<em>p</em> < .001) and previous myocardial infarction (<em>p</em> = .01) were more common in women. Non-native proximal aortic landing was higher in women (women: 51.3%; men: 31.8%, <em>p</em> = .005) and the aortic dissection rate was lower (28.8% <em>vs</em>. 48.1%, <em>p</em> = .005). Proximal landing to Ishimaru zones showed no difference (zone 0: <em>p</em> = .18; zone 1: <em>p</em> = .47; zone 2: <em>p</em> = .39). Graft configurations were equally distributed. In total, 416 supra-aortic trunks were bridged. The median number of revascularisations per patient was two (interquartile range 1, 3), with no difference between sexes (<em>p</em> = .54). Technical success (women: 97.5%; men: 96.9%, <em>p</em> = .80), 30 day mortality rate (women: 10%; men: 9.3%, <em>p</em> = .86), and cerebrovascular morbidity (women: 11.3%; men: 17.1%, <em>p</em> = .25) were similar. Women presented more access related complications (women: 32.5%; men: 16.3%, <em>p</em> = .006), without affecting access related re-interventions (<em>p</em> = .55). Survival (women: 81.1%, 95% confidence interval [CI] 76.3 – 85.9%; men: 79.8%, 95% CI 76.0 – 83.6%) and freedom from re-intervention (women: 56.6%, 95% CI 50.4 – 62.8%; men: 55.3%, 95% CI 50.1 – 60.5%) at 12 months were similar (log rank, <em>p</em> = .40 and <em>p</em> = .41, respectively).</p></div><div><h3>Conclusion</h3><p>Both sexes presented similar outcomes after F/B-Arch. Appropriate patient selection may decrease the effect of sex in F/B-Arch outcomes.</p></div>\",\"PeriodicalId\":55160,\"journal\":{\"name\":\"European Journal of Vascular and Endovascular Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.7000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S1078588424003666/pdfft?md5=e53d8e003a79884735a65e11bba7f41d&pid=1-s2.0-S1078588424003666-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Vascular and Endovascular Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1078588424003666\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Vascular and Endovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1078588424003666","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
Sex Comparative Analysis of Branched and Fenestrated Endovascular Aortic Arch Repair Outcomes
Objective
Female sex is a risk factor for adverse events after endovascular aortic repair. Sex comparative early and midterm outcomes of fenestrated and branched endovascular aortic arch repair (F/B-Arch) are presented.
Methods
A single centre retrospective sex comparative analysis of consecutive patients managed with F/B-Arch was conducted according to STROBE. Primary outcomes were sex comparative technical success, death, and cerebrovascular morbidity at 30 days. Kaplan–Meier estimates were used for follow up outcomes.
Results
Among 209 patients, 38.3% were women. Coronary artery disease (p < .001) and previous myocardial infarction (p = .01) were more common in women. Non-native proximal aortic landing was higher in women (women: 51.3%; men: 31.8%, p = .005) and the aortic dissection rate was lower (28.8% vs. 48.1%, p = .005). Proximal landing to Ishimaru zones showed no difference (zone 0: p = .18; zone 1: p = .47; zone 2: p = .39). Graft configurations were equally distributed. In total, 416 supra-aortic trunks were bridged. The median number of revascularisations per patient was two (interquartile range 1, 3), with no difference between sexes (p = .54). Technical success (women: 97.5%; men: 96.9%, p = .80), 30 day mortality rate (women: 10%; men: 9.3%, p = .86), and cerebrovascular morbidity (women: 11.3%; men: 17.1%, p = .25) were similar. Women presented more access related complications (women: 32.5%; men: 16.3%, p = .006), without affecting access related re-interventions (p = .55). Survival (women: 81.1%, 95% confidence interval [CI] 76.3 – 85.9%; men: 79.8%, 95% CI 76.0 – 83.6%) and freedom from re-intervention (women: 56.6%, 95% CI 50.4 – 62.8%; men: 55.3%, 95% CI 50.1 – 60.5%) at 12 months were similar (log rank, p = .40 and p = .41, respectively).
Conclusion
Both sexes presented similar outcomes after F/B-Arch. Appropriate patient selection may decrease the effect of sex in F/B-Arch outcomes.
期刊介绍:
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.