| 王兰菱,赵蕾,张洪博,鹿冠玉,汪莉莉,卢志辉,马晓海.Stanford B型主动脉夹层经胸主动脉腔内修复后发生内漏的危险因素[J].中国医学影像技术,2026,42(5):702~706 |
| Stanford B型主动脉夹层经胸主动脉腔内修复后发生内漏的危险因素 |
| Risk factors of endoleak in Stanford type B aortic dissection after thoracic endovascular aortic repair |
| 投稿时间：2026-01-05 修订日期：2026-05-15 |
| DOI：10.13929/j.issn.1003-3289.2026.05.010 |
| 中文关键词: 主动脉夹层 动脉瘤腔内修复术 内漏 危险因素 |
| 英文关键词:aortic dissection endovascular aneurysm repair endoleak risk factors |
| 基金项目:国家重点研发计划(2024YFC2417504)。 |
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| 中文摘要: |
| 目的 分析Stanford B型主动脉夹层(TBAD)经胸主动脉腔内修复(TEVAR)后发生内漏的危险因素。方法 回顾性纳入159例接受TEVAR的TBAD患者,分别于治疗后1、6及12个月复查主动脉CT血管成像(CTA);根据末次CTA划分内漏组(n=35)与无内漏组(n=124),比较组间CTA指标,以最小绝对收缩和选择算子算法、单因素及多因素logistic回归筛选内漏危险因素,并以受试者工作特征曲线下面积(AUC)评估其预测效能。结果 内漏组原发破口大小、主动脉最大假腔直径水平(L2)-假腔直径(FD)、距左锁骨下动脉远端15 mm主动脉水平(L3)-主动脉直径(D)、L3-FD、膈膜水平(L5)-D、L5-FD及腹腔动脉上缘水平(L6)-FD均大于无内漏组(P均＜0.05)。校正年龄和性别后,L3-D增大[OR(95%CI)=1.234(1.113,1.368),P＜0.001]为TEVAR后内漏的独立危险因素,L3-D每增加1 mm,内漏风险增加23.40%。最佳截断值为35.95 mm时,以L3-D预测TBAD经TEVAR后发生内漏的敏感度及特异度分别为60.00%及82.26%,其AUC为0.748。结论 L3-D增大是TBAD经TEVAR后发生内漏的独立危险因素。 |
| 英文摘要: |
| Objective To explore the risk factors of endoleak in Stanford type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). Methods Totally 159 TBAD patients who underwent TEVAR were retrospectively enrolled. Aortic CT angiography (CTA) was performed at 1, 6 and 12 months after TEVAR. The patients were divided into endoleak group (n=35) and non-endoleak group (n=124) according to the last CTA, and CTA parameters were compared between groups. Least absolute shrinkage and selection operator, univariate and multivariate logistic regression analyses were performed to screen the risk factors of endoleak after TEVAR, and the predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC). Results The primary entry tear size, false lumen diameter (FD) at the level of the maximum aortic false lumen diameter (L2), aortic diameter (D) and FD at the level of 15 mm distal to left subclavian artery (L3), D and FD at the diaphragmatic level (L5), and FD at the level of superior margin of celiac artery (L6) in endoleak group were all larger than those in non-endoleak group (all P＜0.05). After adjustment for age and gender, increased L3-D was an independent risk factor of endoleak after TEVAR (OR[95%CI]=1.234[1.113, 1.368], P＜0.001), and each 1 mm increase of L3-D corresponded to a 23.40% higher risk of endoleak. Taken 35.95 mm as the optimal cutoff value of L3-D, its sensitivity, specificity and AUC for predicting leakage in TBAD after TEVAR was 60.00%, 82.26% and 0.748, respectively. Conclusion Increased L3-D was an independent risk factor of endoleak in TBAD after TEVAR. |
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