International journal of surgery (London, England) · 2026
Endovascular versus medical management of Type B intramural hematoma: a multicenter retrospective cohort study with propensity score matching.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Zhao Wenpeng, Chen Ke, Zhong Baoliang, Zeng Xiong, Hu Yiliang, Chen Shai, Huang Jingzheng, Li Donglin, Zhou Weimin
Аннотация
BACKGROUND: To evaluate the efficacy of thoracic endovascular aortic repair (TEVAR) and the endovascular intervention window in the treatment of patients with Type B aortic intramural hematoma (TBIMH).
METHODS: This retrospective multicenter cohort study recruited 502 patients with TBIMH from four medical centers in China between 2017 and 2024. The patients were categorized into two groups: the medical management (MM) group ( n = 167) and the TEVAR group ( n = 335). Propensity score matching (PSM) generated 155 matched pairs. Subgroup analysis was conducted within the TEVAR group to compare the survival outcomes associated with three timing windows for TEVAR. The Kaplan-Meier method and log-rank test were employed for survival analysis.
RESULTS: Before PSM, the TEVAR group exhibited higher incidences of comorbidities [e.g., pleural effusion, penetrating atherosclerotic ulcer (PAU), and ulcer-like projection (ULP)] and greater anatomical severity (hematoma thickness and extent) than the MM group. After matching, the two groups were well-balanced in all demographic and clinical variables. The adjusted analysis revealed that TEVAR was associated with lower all-cause mortality (9.68% vs 18.71%, P = 0.034) and improved survival (Log-rank, P = 0.036) compared to MM. A subgroup analysis further indicated that the timing of intervention matters; the hyperacute-phase TEVAR (≤48 hours) was associated with the highest mortality rate (18.18%), whereas survival rates were similar for procedures performed during the acute (3-14 days) and subacute (>14 days) phases.
CONCLUSION: Our study demonstrated that TEVAR was associated with improved survival outcomes compared to MM, including in patients with severe anatomical features. An exploratory analysis suggests that avoiding TEVAR within the hyperacute phase (≤48 hours) might improve outcomes in specific high-risk groups. These findings require confirmation through prospective randomized controlled trials before they can inform definitive clinical practice.
METHODS: This retrospective multicenter cohort study recruited 502 patients with TBIMH from four medical centers in China between 2017 and 2024. The patients were categorized into two groups: the medical management (MM) group ( n = 167) and the TEVAR group ( n = 335). Propensity score matching (PSM) generated 155 matched pairs. Subgroup analysis was conducted within the TEVAR group to compare the survival outcomes associated with three timing windows for TEVAR. The Kaplan-Meier method and log-rank test were employed for survival analysis.
RESULTS: Before PSM, the TEVAR group exhibited higher incidences of comorbidities [e.g., pleural effusion, penetrating atherosclerotic ulcer (PAU), and ulcer-like projection (ULP)] and greater anatomical severity (hematoma thickness and extent) than the MM group. After matching, the two groups were well-balanced in all demographic and clinical variables. The adjusted analysis revealed that TEVAR was associated with lower all-cause mortality (9.68% vs 18.71%, P = 0.034) and improved survival (Log-rank, P = 0.036) compared to MM. A subgroup analysis further indicated that the timing of intervention matters; the hyperacute-phase TEVAR (≤48 hours) was associated with the highest mortality rate (18.18%), whereas survival rates were similar for procedures performed during the acute (3-14 days) and subacute (>14 days) phases.
CONCLUSION: Our study demonstrated that TEVAR was associated with improved survival outcomes compared to MM, including in patients with severe anatomical features. An exploratory analysis suggests that avoiding TEVAR within the hyperacute phase (≤48 hours) might improve outcomes in specific high-risk groups. These findings require confirmation through prospective randomized controlled trials before they can inform definitive clinical practice.