胸腹主动脉扩张性病变平行支架腔内隔绝术内漏发生影响因素分析

doi:10.16139/j.1007-9610.2020.02.012

外科理论与实践 ›› 2020, Vol. 25 ›› Issue (02): 146-151.doi: 10.16139/j.1007-9610.2020.02.012

胸腹主动脉扩张性病变平行支架腔内隔绝术内漏发生影响因素分析

艾克白尔江·艾尼瓦尔¹^,², 冯睿¹, 冯家烜¹, 吴明炜¹, 赵玉玺¹, 景在平¹()

1.海军军医大学附属长海医院血管外科,上海 200433
2.新疆喀什地区第二人民医院普外科,新疆喀什 844000

收稿日期:2019-05-05 出版日期:2020-03-25 发布日期:2020-04-25
通讯作者: 景在平,E-mail: jingzp@xueguan.net
基金资助:
国家自然科学基金(81770476);国家自然科学基金(81500369)

Analysis of factors influencing endoleak following endovascular repair using parallel stent technique for thoracic and abdominal aortic dilatation

AIKEBAIER Aniwaer¹^,², FENG Rui¹, FENG Jiaxuan¹, WU Mingwei¹, ZHAO Yuxi¹, JING Zaiping¹()

1. Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai 200433, China
2. Department of General Surgery, the Second People' s Hospital of Kashi Region, Kashi Xinjiang 844000, China

Received:2019-05-05 Online:2020-03-25 Published:2020-04-25

摘要/Abstract

摘要：

目的: 分析胸腹主动脉扩张性病变,采用平行支架技术（烟囱支架技术）腔内隔绝术后发生内漏的危险因素,为预防发生提供数据。方法: 回顾性分析长海医院血管外科2011年1月至2018年3月胸腹主动脉扩张性病变平行支架技术腔内隔绝术病人50例,分为内漏组和无内漏组,分析内漏的危险因素。结果: 本研究共有平行支架部位68个,其中烟囱支架数目90枚。术中造影发现Ⅰ型内漏28个（41.2%）,随访发现Ⅰ型内漏12个（17.6%）。单因素分析发现,血管内平行动脉口径比值≥1.44,支架内平行动脉口径比值≤1.53,Gore主体支架与外周覆膜支架平行,这3个因素是内漏的相关因素（P<0.05）。Logistic回归分析显示,平行支架数目是内漏发生的相关因素（P<0.05）。结论: 本研究发现胸腹主动脉扩张性疾病平行支架腔内隔绝术的内漏与平行支架间口径匹配、平行支架数目,及平行支架在血管内平行还是支架内平行有关。

关键词: 胸腹主动脉扩张性病变, 平行支架技术, 内漏

Abstract:

Objective: To analysis the risk factors influencing endoleak following endovascular repair using parallel stent technique for thoracic and abdominal aortic dilation in order to prevent endoleak. Methods: A retrospective analysis was performed on 50 patients with thoracic and abdominal aortic dilation undergoing endovascular repair with parallel stent technique including endoleak group and without endoleak group from January 2011 to March 2018 at Department of Vascular Surgery, Changhai Hospital. The risk factors of endoleak were analyzed. Results: There were 68 parallel stent grafts in this study including 90 chimney stents. Intraoperative angiography found type Ⅰ endoleak in 28 cases (41.2%) and follow up study showed type Ⅰ endoleak in 12 cases (17.6%). There were three factors correlated with endoleak including the ratio of diameter of parallel artery ≥1.44 in vessel, the ratio of diameter of parallel artery ≤1.53 in stent, and parallel between Gore stent and peripheral coated stent according to univariate analysis (P<0.05). Logistic regression analysis showed that the number of parallel stents was an independent factor correlated with endoleak(P<0.05). Conclusions: Diameter matching between parallel stents, the number of parallel stents and stents parallel in vessels or in stent grafts were associated the endoleak of endovascular repair with parallel stent technique for thoracic and abdominal aortic dilatation shown in this study.

Key words: Thoracic and abdominal aortic dilatation, Parallel stent technique, Endoleak

中图分类号:

R654.3

艾克白尔江·艾尼瓦尔, 冯睿, 冯家烜, 吴明炜, 赵玉玺, 景在平. 胸腹主动脉扩张性病变平行支架腔内隔绝术内漏发生影响因素分析[J]. 外科理论与实践, 2020, 25(02): 146-151.

AIKEBAIER Aniwaer, FENG Rui, FENG Jiaxuan, WU Mingwei, ZHAO Yuxi, JING Zaiping. Analysis of factors influencing endoleak following endovascular repair using parallel stent technique for thoracic and abdominal aortic dilatation[J]. Journal of Surgery Concepts & Practice, 2020, 25(02): 146-151.

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参考文献 14

[1]	Best WB, Ahanchi SS, Larion S, et al. Abdominal aortic aneurysm anatomic severity grading score predicts implant-related complications, systemic complications, and mortality[J]. J Vasc Surg, 2016, 63(3):577-584. doi: 10.1016/j.jvs.2015.09.029 URL
[2]	Khashram M, Williman JA, Hider PN, et al. Systematic review and meta-analysis of factors influencing survival following abdominal aortic aneurysm repair[J]. Eur J Vasc Endovasc Surg, 2015, 51(2):203-215. doi: 10.1016/j.ejvs.2015.09.007 URL
[3]	Steuer J, Lachat M, Veith FJ, et al. Endovascular grafts for abdominal aortic aneurysm[J]. Eur Heart J, 2016, 37(2):145-151. doi: 10.1093/eurheartj/ehv593 URL
[4]	曹旭, 张耀中, 秦彦文. 腹主动脉瘤发病机制的研究进展[J]. 心肺血管病杂志, 2012, 31(6):759-761.
[5]	Paravastu SC, Jayarajasingam R, Cottam R, et al. Endovascular repair of abdominal aortic aneurysm[J]. Cochrane Database Syst Rev, 2014,CD004178.
[6]	Greenberg RK, Clair D, Srivastava S, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair?[J]. J Vasc Surg, 2003, 38(5):990-996. pmid: 14603205
[7]	景在平, 梅志军. 针对腔内隔绝术的主动脉夹层分型的探讨[J]. 中华外科杂志, 2005, 43(13):894-895.
[8]	景在平. 主动脉夹层的诊断和腔内隔绝术应用指南(初稿)[J]. 中国实用外科杂志, 2004, 24(3):129-133.
[9]	Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery[J]. J Vasc Surg, 1991, 13(3):452-458. pmid: 1999868
[10]	Shang EK, Nathan DP, Sprinkle SR, et al. Peak wall stress predicts expansion rate in descending thoracic aortic aneurysms[J]. Ann Thorac Surg, 2013, 95(2):593-598. doi: 10.1016/j.athoracsur.2012.10.025 pmid: 23245445
[11]	Knepper J, Upchurch GR. A review of clinical trials and registries in descending thoracic aortic aneurysms[J]. Semin Vasc Surg, 2010, 23(3):170-175. doi: 10.1053/j.semvascsurg.2010.05.005 pmid: 20826294
[12]	Elkouri S, Martelli E, Gloviczki P, et al. Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts[J]. Vasc Endovascular Surg, 2004, 38(5):401-412. doi: 10.1177/153857440403800502 URL
[13]	XiaoHui M, Wei G, ZhongZhou H, et al. Endovascular repair with chimney technique for juxtarenal aortic aneurysm: a single center experience[J]. Eur J Endovasc Surg, 2015, 49(3):271-276. doi: 10.1016/j.ejvs.2014.11.012 URL
[14]	Tran K, Ullery BW, Itoga N, et al. Polar orientation of renal grafts within the proximal seal zone affects risk of early type IA endoleaks after chimney endovascular aneury-sm repair[J]. J Vasc Surg, 2018, 67(4):1034-1041. doi: 10.1016/j.jvs.2017.08.059 URL

指标	内漏	无内漏	内漏发生率(%)	P值
平行支架数（枚） ①1 ②2 ③3	20 8 0	27 12 1	42.6 40.0 0	0.574
平行支架重叠长度(mm) >35 ≤35	17 11	23 17	42.5 39.3	0.791
支架大小差异大小	20 8	31 9	39.2 47.1	0.569
平行支架方向顺逆	21 7	33 7	38.9 50.0	0.452
平行支架部位血管内平行支架内平行	9 19	15 25	37.5 43.2	0.649
主体支架品牌 Gore（a） Medtronic(b) Micro port (c)	20 3 5	31 3 6	39.2 50.0 45.5	0.703(ac) 0.613(ab) 0.627(bc)
平行支架位置 V3区（a） N3C区（b） N3I区（c）	14 5 9	22 7 11	38.9 41.7 45.0	0.865(ab) 0.434(ac) 0.574(bc)

指标	内漏（n=9）	无内漏（n=15）	内漏发生率(%)	P值
动脉口径比值 <1.44 ≥1.44	6 3	2 13	75 18.75	0.021^a)
主体支架品牌 Gore（a）微创(b) Medtronic(c)	4 4 1	13 0 2	23.5 100 33.3	0.012^a)(ab) 0.601(ac) 0.143(bc)
V3区血管内平行方向顺逆	7 2	13 2	35 50	0.576
肾单烟囱顺方向肾双烟囱顺方向	4 3	8 4	33.3 42.9	0.679
V3区血管内平行支架重叠长度(mm) 25~60 10~24	3 6	7 8	25 40	0.418
V3区肾单烟囱肾双烟囱	6 3	10 4	37.5 42.9	0.809
肾单烟囱顺方向肾单烟囱逆方向	4 2	8 2	33.3 50	0.555

影响因素	内漏（n=19）	无内漏（n=25）	内漏发生率(%)	P值
动脉口径比值 ≤1.53 >1.53	7 12	17 8	29.2 60	0.04^a)
主体支架品牌 Gore(a) Micro port(b) Medtronic(c)	16 1 2	18 6 1	47.1 14.3 66.6	0.207(ab) 0.604(ac) 0.183(bc)
平行支架方向顺逆	14 5	20 5	41.1 50	0.279
支架大小差异大小	11 8	16 9	40.7 47.1	0.76
V3区支架内平行重叠长度(mm) 45~86 30~44	1 4	4 3	20 57.1	0.293
V3区血管内平行支架内平行	9 5	15 7	37.5 41.7	0.809
N3区主体支架品牌 Gore(a) 微创(b)	13 0	12 5	52 0	0.052(ab) 0.741(ac)
Medtronic(c)	1	1	50	0.286(bc)

影响因素	B	偏差	标准误	P值	95% CI
支架数目	20.378	-0.348	0.825	0.019^a)	19.914~20.605
支架重叠长度	-0.092	-0.266	0.646	0.870	-1.261~0.455
支架大小差异	1.024	0.311	0.737	0.130
平行支架方向	-0.660	-0.443	3.237	0.315	-19.097~0.996
主体支架品牌	0.171	-0.095	0.753	0.759	-1.333~1.406

胸腹主动脉扩张性病变平行支架腔内隔绝术内漏发生影响因素分析

Analysis of factors influencing endoleak following endovascular repair using parallel stent technique for thoracic and abdominal aortic dilatation

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