[Analysis of factors influencing the remodeling of abdominal false lumen after thoracic aortic endovascular repair].

Objective: To examine the factors influencing the false lumen remodeling of abdominal aortic segment in the midterm and longterm after thoracic endovascular aortic repair (TEVAR). Methods: The data of patients with type B aortic dissection diagnosed and underwent TEVAR at the Department of Vascular and Endovascular Surgery, the First Medical Center, People's Liberation Army General Hospital, from November 2009 to November 2019 were analyzed retrospectively. Patients of acute or subacute long segment dissection with residual tears of abdominal but no thoracic segment and follow-up for more than one year were enrolled. Patients with operation-related complications, and dissection caused by trauma and Marfan syndrome were excluded. A total of 51 patients were enrolled, including 45 males and 6 females, with an age of (49.4±10.6) years (range: 31 to 72 years). The patients included in the analysis were divided into stable and enlarged group. The criteria for inclusion in the enlarged group were any of the following: (1) the maximum growth rate of the abdominal segment false lumen was ≥3 mm/year; (2) the maximum diameter of the abdominal aorta was ≥50 mm; (3) the diameter of the abdominal segment false lumen increased more than 10 mm. χ2 test, t-test and nonparametric test were used for univariate analysis. The variables with P≤0.1 were included in the Logistic multivariate stepwise regression to analyze the independent correlation factors, and the receiver operating characteristic (ROC) curve was used to calculate the cut-off value of the quantitative data. Results: All patients were divided into stable group (n=30) and enlarged group (n=21). The follow-up time of all patients was 42(29) months (range: 12 to 115 months). There were no significant differences in baseline characteristics, endovascular treatment characteristics and postoperative medication between the two groups (P>0.05). Compared with stable group,the number of residual tears around visceral arteries was more (2(1) vs. 1(1), Z=-2.829, P=0.005) and the number of lumbar arteries originating from false lumen was more (5(6) vs. 3(5), Z=-2.025, P=0.043) early after TEVAR in enlarged group. The number of residual tears around visceral arteries (OR=3.966, 95%CI: 1.552 to 10.131, P=0.004) was found to be the independent influence factor for the poor remodeling of the abdominal false lumen in multivariate Logistic regression analysis. ROC curve analysis showed that the cut-off value of the number of residual tears around visceral arteries was 2 at least (area under curve: 0.718). Conclusion: The incidence of poor remodeling of the abdominal false lumen after TEVAR was high. The number of residual tears around visceral arteries (≥2) could be independent influence factor to predict the poor remodeling of abdominal false lumen, and the follow-up of such patients should be strengthened in clinic.目的： 探讨胸主动脉腔内修复术（TEVAR）后中远期腹段假腔重塑的影响因素。 方法： 回顾性分析2009年11月至2019年11月在解放军总医院第一医学中心血管外科确诊为Stanford B型主动脉夹层（B型夹层）并接受TEVAR治疗的患者资料。纳入术后腹主动脉段有残余裂口而胸段无裂口、随访1年以上的急性或亚急性长段夹层病例，排除存在手术相关并发症及创伤、马方综合征导致夹层的病例。最终纳入51例患者，男性45例，女性6例，年龄（49.4±10.6）岁（范围：31~72岁）。患者符合下述任何一条标准归入扩张组：（1）腹段假腔最大增长速度≥3 mm/年；（2）腹主动脉最大径≥50 mm；（3）腹段假腔直径增长≥10 mm。采用χ²检验、t检验及非参数检验进行单因素分析。将P≤0.1的变量纳入Logistic回归进行多因素分析，并用受试者工作特征曲线计算定量资料的截点值。 结果： 稳定组30例，扩张组21例。与稳定组相比，扩张组术后早期内脏动脉段残余裂口数量更多［2（1）个比1（1）个，Z=-2.829，P=0.005］，腰动脉发自假腔数量更多［5（6）支比3（5）支，Z=-2.025，P=0.043］。多因素分析结果显示，内脏动脉段残余裂口数量（OR=3.966，95%CI：1.552~10.131，P=0.004）是腹段假腔重塑不良的独立影响因素。受试者工作特征曲线显示，内脏动脉段残余裂口数量截点值为≥2个，曲线下面积为0.718。 结论： TEVAR后腹段假腔不良重塑发生率高。内脏动脉段残余裂口数量≥2个是腹段假腔重塑不良的独立影响因素，临床应加强对此类患者的随访。.