目的:涉及主动脉弓2区的手术需要进行左侧椎动脉血运重建,通常通过锁骨下动脉血运重建间接完成。对于异常的左侧椎骨解剖,指示直接血运重建。我们的目的是比较直接椎动脉血运重建和间接锁骨下动脉血运重建治疗主动脉弓病变的结果,并确定死亡率的预测因素。
方法:在一家三级医院进行了一项回顾性队列研究,包括2005年至2022年进行了开放或血管内椎动脉血运重建的患者.将进行直接椎体血运重建的患者与通过锁骨下动脉血运重建间接血运重建的患者进行比较。感兴趣的结果是一个复合结果(任何死亡,中风,神经损伤,血栓形成)和死亡率。拟合单变量逻辑回归模型以量化直接和间接血运重建队列之间的差异强度。Cox回归用于确定死亡率预测因子。
结果:在143例接受椎动脉血运重建的患者中,21例(14.7%)患者的椎动脉起源于主动脉弓。中位住院时间为10天(IQR,6-20天),队列之间的人口统计学特征相似[表一]。复合结局的发生率,直接组的旁路血栓形成和声音嘶哑明显更高(42.9%vs.18.0%,p=0.019;33.3%vs.0.8%,p<0.0001;57.1%vs.18.0%,p分别<0.001)。直接组经历复合结果的可能性要高出3倍(赔率比[OR],3.41;95%CI,1.28,9.08);同样,这一组患声音嘶哑的可能性要高出6倍(或者,5.88;95%CI,2.21,15.62)[表二]。30天的死亡率没有显着差异,1-,3-,5年和10年的随访。年龄,住院时间,和充血性心力衰竭被确定为较高死亡率的预测因子。在调整这些协变量后,该组本身并不是死亡率的独立预测因子[表三].
结论:直接椎体血运重建与更高的旁路血栓形成率相关,复合结局(死亡,中风,神经损伤,血栓形成)和声音嘶哑。与具有标准弓解剖结构的患者相比,具有异常椎骨解剖结构的患者发生这些并发症的风险更高。然而,在调整了其他因素后,各组间死亡率无显著差异.
OBJECTIVE: Left vertebral artery revascularization is indicated in surgery involving zone 2 of the aortic arch and is typically accomplished indirectly via subclavian artery revascularization. For aberrant left vertebral anatomy, direct revascularization is indicated. Our objective was to compare the outcomes of direct vertebral artery revascularization with indirect subclavian artery revascularization for treating aortic arch pathology and to identify predictors of mortality.
METHODS: A retrospective cohort
study was conducted at a single tertiary hospital, including patients who underwent open or endovascular vertebral artery revascularization from 2005 to 2022. Those who underwent direct vertebral revascularization were compared with those who were indirectly revascularized via subclavian artery revascularization. The outcomes of interest were a composite outcome (any of death, stroke, nerve injury, and thrombosis) and mortality. Univariate logistic regression models were fitted to quantify the strength of differences between the direct and indirect revascularization cohorts. Cox regression was used to identify mortality predictors.
RESULTS: Of 143 patients who underwent vertebral artery revascularization, 21 (14.7%) had a vertebral artery originating from the aortic arch. The median length of stay was 10 days (interquartile range, 6-20 days), and demographics were similar between cohorts. The incidence of composite outcome, bypass thrombosis, and hoarseness was significantly higher in the direct group (42.9% vs 18.0%, P = .019; 33.3% vs 0.8%, P < .0001; 57.1% vs 18.0%, P < .001, respectively). The direct group was approximately three times more likely to experience the composite outcome (odds ratio, 3.41; 95% confidence interval, 1.28, 9.08); similarly, this group was approximately six times more likely to have hoarseness (odds ratio, 5.88; 95% confidence interval, 2.21, 15.62). There was no significant difference in mortality rates at 30 days, 1, 3, 5, and 10 years of follow-up. Age, length of hospital stay, and congestive heart failure were identified as predictors of higher mortality. After adjusting for these covariates, the group itself was not an independent predictor of mortality.
CONCLUSIONS: Direct vertebral revascularization was associated with higher rates of composite outcome (death, stroke, nerve injury, and thrombosis), bypass thrombosis and hoarseness. Patients with aberrant vertebral anatomy are at higher risks of these complications compared with patients with standard arch anatomy. However, after adjusting for other factors, mortality rates were not significantly different between the groups.