背景:本研究旨在评估在胸主动脉腔内修复术(TEVAR)治疗主动脉夹层(AD)中应用Candy-Plug(CP)技术治疗远端假腔(FL)的早期和中期结果的紧迫性影响。
方法:对CP注册进行了综述,将患者分为择期组和紧急/紧急组进行分析.终点包括技术成功,临床成功,早期(30天)计算机断层扫描血管造影(CTA)发现,早期(30天)死亡率,不良事件,主动脉重构患者可获得CTA随访和再干预。
结果:共有155名患者接受了定制的Candy-Plug,其中32名患者(男性占44%,平均年龄61±9岁)被紧急治疗与123名患者(63%为男性,平均年龄62±11岁)。紧急组的主要CP率较高;(紧急组的28/32,(88%)选修组96/123(78%),p=051)。紧急组平均对比体积较高;(紧急组157±56mlvs.选修组130±71ml,p=.017)。两组患者均取得技术成功。临床成功在25/32(78%)的患者中获得了113/123(92%)在选修组中,p=.159。早期死亡率为4/32,(13%)患者在紧急组选修组1/123(1%),p=.120)。关于紧急和选择性CP组之间的早期不良事件,没有统计学上的显着差异。紧急组患者中有6/32(19%)需要早期与主动脉相关的再干预6/123(5%)在选修组中,p=.094。紧急组的胸主动脉瘤囊消退较低(紧急组的5/28,(18%)选修组63/114(55%),p=001)。稳定的胸主动脉瘤囊在紧急组中较高(22/28,(79%)选修组47/114(41%),p=000)。1/28(4%)患者的胸主动脉瘤囊增加4/114(4%)患者在择期组,p=.096。
结论:紧急使用CP技术治疗AD远端FL闭塞是可行和有效的。由于尺寸限制,紧急使用CP可能会影响主动脉FL囊直径的减小。然而,它实现了高的主动脉重塑率。
OBJECTIVE: This study aimed to assess the impact of urgency on early and midterm outcomes of the Candy-Plug (CP) technique for distal false lumen (FL) occlusion in thoracic endovascular aortic repair for aortic dissection.
METHODS: The CP registry was reviewed, and patients were categorized into elective and urgent/emergent groups for analysis. End points included technical success, clinical success, early (30-day) computed tomography angiography findings, early (30-day) mortality, adverse events, and aortic remodeling in patients with available computed tomography angiography follow-up and reintervention.
RESULTS: A total of 155 patients received a custom-made CP, of whom 32 patients (44% male, mean age 61 ± 9 years) were treated urgently and 123 patients (63% male, mean age 62 ± 11 years) electively. The primary CP rate was higher in the urgent group (28/32, 88%, in the urgent group vs 96/123, 78%, in the elective group, P = .051). The mean contrast volume was higher in the urgent group (157 ± 56 mL in the urgent group vs 130 ± 71 mL in the elective group, P = .017). Technical success was achieved in all patients in both groups. Clinical success was achieved in 25 of 32 (78%) patients in the urgent group vs 113 and 123 (92%) in the elective group (P = .159). The early mortality rate was 13% (4 of 32 patients) in the urgent group vs 1% (1 of 123 patients) in the elective group (P = .120). There was no statistically significant difference regarding the early adverse events between the urgent and elective CP groups. Early aortic-related reinterventions were required in 6 of 32 (19%) patients in the urgent group vs 6 of 123 (5%) in the elective group (P = .094). Thoracic aortic aneurysm sac regression was lower in the urgent group (5/28, 18%, in the urgent group vs 63/114, 55%, in the elective group, P = .001). Stable thoracic aortic aneurysm sac was higher in the urgent group (22/28, 79%, in the urgent group vs 47/114, 41%, in the elective group, P = .000). An increase in thoracic aortic aneurysm sac occurred in 1 of 28 (4%) patients in the urgent group vs 4 of 114 (4%) patients in the elective group (P = .096).
CONCLUSIONS: The urgent use of the CP technique for distal FL occlusion in aortic dissection was feasible and effective. The decrease in aortic FL sac diameter may be affected by the urgent use of CP due to limited sizing availability. However, it achieved a high rate of aortic remodeling.