Analysis Of Influencing Factors Of Aortic Remodeling After Endovascular Repair Of DeBakey Type Ⅲb Aortic Dissection In Acute Stage

Objective:To study the analysis of related factors that affect the effect of aortic remodeling after thoracic endovascular aortic repair(TEVAR)with DeBakey typeⅢb aortic dissection in the acute phase.Methods:In this study,retrospective analysis was used to collect relevant clinical information of patients with acute stage DeBakey Ⅲb aortic dissection(AD)who met the inclusion and exclusion criteria from January 2017 to April 2020 in the Department of Interventional Vascular Surgery,Hunan Provincial People’s Hospital Data and imaging data,including specific content:(1)Count the total aortic CTA of the patients before the operation according to the first proximal rupture to the upper part of the celiac trunk,between the celiac trunk and the bilateral renal arteries,and below the bilateral renal arteries.The number of rupturees seen and their location;(2)Collect laboratory indicators that may be related to blood vessels when each patient is admitted to the hospital for examination,such as blood type,preoperative neutrophil percentage,C-reactive protein,lipoprotein-related phospholipase A2,Urea nitrogen,triglycerides,L-lactate dehydrogenase,etc.;(3)After the stent is released during TEVAR operation,record the position of the distal regurgitation rupture and the time required for the contrast agent to fill the false lumen(s);(4)surgery After the patient was discharged from the hospital,recheck the whole aorta CTA to observe whether or not there is blood supply from other branch vessels in the patient’s false lumen.During follow-up,observe the patient’s whole aortic CTA after 3,6,and 12months.Take the last re-examination result>3 months and compare it with the preoperative total aortic CTA.By measuring the relatively constant cross-sections(bronchial bifurcation plane,celiac artery plane,iliac artery bifurcation plane)true lumen(TL),false lumen(FL)area(mm ~2)and record the thrombosis in the false lumen in the corresponding cross-section,so as to understand the aortic remodeling effect of each segment of the descending aorta(the area change of the corresponding cross-section of the true/false lumen and False lumen thrombosis).Divide the patient’s aortic remodeling effect into bronchial bifurcation plane aortic remodeling group with better prognosis(including complete thrombosis of false lumen,partial thrombosis of false lumen,and loss of false lumen absorption)and better prognosis of aortic remodeling effect Poor group(false lumen without thrombosis),based on the collected preoperative laboratory test results and imaging results of patients in the good prognosis group and the poor prognosis group to analyze the impact of various indicators on the effect of aortic remodeling.Results:According to statistics,a total of 257 patients with DeBakey Ⅲb type aortic dissection underwent TEVAR from January 2017 to April2020 in the Department of Interventional Vascular Surgery,Hunan Provincial People’s Hospital,of which 40 patients met the inclusion and exclusion criteria,were included in the group.The stent graft was used to seal the proximal rupture during the operation,and no special treatment was performed on the distal rupture.The success rate of TEVAR surgery was 100%.The results of the CTA analysis of the whole aorta of the 40patients showed that the CTA re-examined more than 3 months after TEVAR showed that the true lumen of the thoracic aorta segment(the plane of the bronchus bifurcation)was enlarged and the false lumen was reduced more significantly than before the operation,and the difference was statistically significant.Significance(all P<0.05);while in the abdominal aorta segment and beyond(the plane of the abdominal trunk artery,the plane of the iliac artery bifurcation),although the true lumen is enlarged and the false lumen is reduced,there is no statistical difference from preoperative Significance(all P>0.05);The effect of aortic remodeling in the thoracic aorta and abdominal aorta segments(bronchial bifurcation plane,celiac arterial plane)in patients with contrast agent filling the false lumen for more than 2 seconds after surgery is better than angiography There was a statistically significant difference in patients with a false lumen filling time of less than 2 seconds(all P<0.05),but there was no significant difference in the effect of aortic remodeling between the two groups in the iliac aorta(the bifurcation plane of the iliac artery).Based on the collected preoperative laboratory test results and imaging results of patients in the good prognosis group and the poor prognosis group,the univariate analysis of the impact of various indicators on the effect of aortic remodeling(P<0.1),and the use of multiple factors Logistic regression analysis further analyzed the above variables,and the results showed that the false lumen with branch vascular perfusion was an independent risk factor for poor prognosis of aortic remodeling(OR=23.86,P<0.05).Conclusion:1.In the acute stage of DeBakey typeⅢb aortic dissection after TEVAR,the remodeling effect of the descending thoracic aorta segment is better than that of the abdominal aorta and the aorta beyond.2.The perfusion of branch vessels in the false cavity of the dissection is an independent risk factor that affects the poor remodeling of DeBakey Ⅲb aortic dissection in the acute phase.3.After the stent is released during TEVAR operation,there is a rupture in the distal aorta and the filling time of contrast agent in the dissection false cavity is relatively short,and the dissection involves a wide range of the aorta(DeBakey Ⅲb type dissection)or there is a false cavity in the dissection.In patients with branch vessel perfusion,the effect of postoperative aortic remodeling may be poor.It is recommended that the distal rupture be treated or closely observed and followed up.