通过胸腔内血管修复和裸支架延伸改善主动脉重塑的成功因素

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Journal of Vascular Surgery Pub Date : 2024-10-19 DOI:10.1016/j.jvs.2024.10.025
Mio Kasai, Kenichi Hashizume, Tadashi Matsuoka, Mitsuharu Mori, Toshiaki Yagami, Kiyoshi Koizumi, Hiroaki Kaneyama, Yuika Kameda, Tsutomu Nara, Mayu Nishida, Misato Tokioka, Hideyuki Shimizu
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引用次数: 0

摘要

目的:利用下游裸金属支架提供结构支持的 "近端张力诱导完全附着"(PETTICOAT)具有巨大潜力,但其应用却因结果不一而受到限制。本研究阐明了 PETTICOAT 在主动脉夹层中的潜力,强调了指导患者选择的决定因素:方法:对 60 名接受全 PETTICOAT 治疗主动脉夹层的患者进行了回顾性分析。多变量逻辑回归模型确定了有利主动脉重塑的预测因素。患者接受了标准化的 CT 扫描随访,以评估大小、容积变化和解剖条件。选择标准包括完全应用 PETTICOAT 和至少三个月的随访。收集并分析了人口统计学、术前情况和手术细节:分析确定了有利主动脉重塑的预测因素,包括年龄超过60岁、下游主动脉支架移植较大、腹主动脉较小(2)以及口服血管紧张素II受体阻滞剂(ARB)。在中位 47.5 个月的随访中,重塑有利组(97.3%)和重塑不利组(100%)的存活率相似。下游主动脉无事件生存率没有明显差异(89.2% 对 73.9%),但不利组远端支架诱发新入口的发生率相对较高(26.1% 对 8.1%):结论:PETTICOAT 概念能有效改善复杂主动脉夹层的主动脉重塑。有利重塑的预测因素包括年龄、支架移植物尺寸、主动脉直径和 ARB 治疗,这些因素为优化患者选择提供了启示。这种方法提高了患者的生存率,降低了未经治疗的主动脉段的相关风险,并为主动脉夹层提供了一种微创解决方案。尽管结果存在一些差异,但该技术有望解决主动脉夹层的难题,并有可能进一步完善患者选择和技术应用。
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Successful factors for improving aortic remodeling with thoracic endovascular repair and bare stent extension.

Objective: Proximal ExTension to Induce COmplete ATtachment (PETTICOAT), which uses downstream bare metal stents for structural support, demonstrates potential, yet its adoption is limited by variable outcomes. This study elucidates the potential of PETTICOAT in aortic dissection, emphasizing the determinants that guide patient selection.

Methods: A retrospective analysis of 60 patients who underwent full PETTICOAT for aortic dissections was conducted. A multivariate logistic regression model identified predictors of favorable aortic remodeling. Patients underwent standardized follow-up with computed tomography scans to assess size, volumetric changes, and anatomical conditions. Selection criteria included full PETTICOAT application and a minimum of 3 months of follow-up. Demographics, preoperative conditions, and procedural details were collected and analyzed.

Results: The analysis identified predictors of favorable aortic remodeling, including age >60 years, a larger downstream aorta stent graft, a smaller abdominal aorta (<450 mm2), and oral angiotensin II receptor blocker administration. Over a median 47.5 months of follow-up, survival rates in the favorable remodeling (97.3%) and unfavorable groups (100%) were similar. Downstream aortic event-free survival rates did not differ significantly (89.2% vs 73.9%), although the unfavorable group had a relatively higher incidence of distal stent-induced new entries (26.1% vs 8.1%).

Conclusions: The PETTICOAT concept effectively enhances aortic remodeling in complex aortic dissections. Predictors for favorable remodeling, including age, stent graft sizing, aortic diameter, and angiotensin II receptor blocker therapy, offer insights for optimizing patient selection. This approach improves survival outcomes, mitigates risks associated with untreated aortic segments, and provides a minimally invasive solution for aortic dissections. Despite some outcome variations, the technique holds promise for addressing the challenges of aortic dissections, with the potential for further refinement in patient selection and technique application.

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来源期刊
CiteScore
7.70
自引率
18.60%
发文量
1469
审稿时长
54 days
期刊介绍: Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.
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