| Purpose:To identify the risk factors for reintervention in patients who underwent thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(TBAD).Methods:192 TBAD patients who underwent TEVAR between October 2011 and September 2018 were included.Clinical features,morphologic characteristics of the aorta on the preoperative computer tomography angiography(CTA)and immediate postoperative aortic digital subtraction angiography(DSA)were retrospectively collected.Univariate and multivariate Cox regressions were applied to identify independent risk factors for reintervention after TEVAR.Follow-up information was obtained from CTA and telephone.Survival follow-up ended on January 20,2020.The cumulative rate of freedom reintervention sign and long-term survival after TEVAR was analyzed by kaplan-meier curve and compared by log-rank test.Results:68(35.4%)patients showed reintervention signs after TEVAR(reintervention group,n=68).The mean follow-up time of CTA in 192 patients was(30.9 ± 1.42)months,and the median follow-up time of reintervention group was 19 months.A total of 16 patients after TEVAR were dead,and 22 patients were lost to follow-up.The overall mortality rate was 9.4%.Basing on the Kaplan-Meier analysis,the 5-year reintervention-free rate was 51.3%.The 5-year survival rate in the reintervention group was 86.1%,and the 5-year survival rate in the non-reintervention group was 95.6%.The 8-year survival rate in the reintervention group was 67.2%,and the 8-year survival rate in the non-reintervention group was 93.8%on Kaplan-Meier survival analysis.According to the multiple factors Cox regression model,we identified six independent risk factors for reintervention sign,including age>66.5 years(Hazard ratio[HR],2.26;95%confidence interval[CI]:1.18-4.34,P=0.014),total aortic diameter at the level of approximately 15 mm distal to the left subclavian artery(PreL1D)>38.5 mm(HR,1.91;95%CI:1.16-3.15,P=0.011),false lumen diameter at the level of the celiac artery(PreL4FD)>17.5 mm(HR,2.71,95%CI:1.53-4.79,P=0.001),the medium and large amount of immediate-endoleak in TEVAR(HR,4.37;95%CI:2.04-9.37,P<0.001),the number of bare stents(HR,1.86;95%CI:1.17-2.95,P=0.009)and chimney technique(HR,1.92,95%CI:1.05-3.53,P=0.031).55 patients with zero independent risk factor,and the incidence of reintervention signs was 9.1%(5/55).68 patients with an independent risk factor,the incidence of reintervention signs was 25.0%(17/68).52 patients with two independent risk factors,and the incidence of reintervention signs was 57.7%(30/52).13 patients with three independent risk factors,and the incidence of reintervention signs was 92.3%(12/13).Four patients with four independent risk factors,and the incidence of reintervention signs was 100%(4/4).About 66.7%of TBAD patients with two or more risk factors showed reintervention signs,while 17.9%of patients with only one or zero risk factor occurred.The incidence of reintervention signs after TEVAR in TBAD patients significantly increased with the increase of the number of risk factors(46/69 vs.22/123;P<0.001,cochran-armitage trend test P<0.001).Conclusions:Age>66.5 years,total aortic diameter at the level of approximately 15 mm distal to the left subclavian artery(PreL1D)>38.5 mm,false lumen diameter at the level of the celiac artery(PreL4FD)>17.5 mm,the medium and lager amount of immediate-endoleak in TEVAR,the number of bare stents and chimney technique were risk factors for the occurrence of reintervention signs after TEVAR in TBAD patients.The number of risk factors was positively correlated with the occurrence of reintervention signs.The result may be help to select appropriate patients for TEVAR.The high-risk patients with two or more risk factors should be followed up more closely and develop a more reasonable management plans,which would help doctors to identify the occurrence of reintervention signs as early as possible,and to timely treatment.These protocols can reduce the occurrence of aortic ruptured and death. |
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