Cheng Koon-Sung, Tiwari Alok, Morris Richard, Hamilton George, Seifalian Alexander M
Cardiovascular Haemodynamic Unit, University Department of Surgery, Royal Free and University College Medical School, London, United Kingdom.
J Vasc Surg. 2003 Feb;37(2):403-9. doi: 10.1067/mva.2003.52.
Aortic and carotid stiffness is elevated in patients with abdominal aortic aneurysm (AAA). Peripheral vascular disease (PVD) frequently coexists with AAA and may further impair the arterial wall mechanics and increase the cardiovascular load. We therefore studied the elastic carotid and muscular femoral biomechanical properties and intima-media thickness (IMT) in this group of patients.
The elastic indices and IMTs of the common carotid and common femoral arteries were determined in 30 patients with AAA (15 with PVD) with a duplex scanner coupled with a wall tracking system. Fasting plasma creatinine level, glucose and lipid concentrations, and their physiologic variables known to influence the arterial wall mechanics were also assessed.
Patients with AAA and PVD have significantly stiffer carotid (Petersen's elastic modulus, 2207 +/- 905 mm Hg versus 1268 +/- 432 mm Hg; P =.001; stiffness index, 22.73 +/- 9.63 versus 12.60 +/- 4.24; P =.001] and femoral (Petersen's elastic modulus, 4906 +/- 4057 mm Hg versus 2599 +/- 1169 mm Hg; P =.043; stiffness index, 49.02 +/- 40.04 versus 26.07 +/- 13.22; P =.044) arteries than subjects with AAA alone. Although patients with PVD have thicker carotid and femoral IMTs, no statistical difference was seen between the two groups. The subjects were matched for age, body mass index, heart rate, systolic and diastolic blood pressures, total vascular risk score, plasma creatinine level, and fasting lipid and glucose concentrations.
Subjects with PVD and AAA have significantly stiffer carotid and femoral arteries, which may indicate increased cardiovascular load and may account for the highest mortality rate seen in these patients in the UK Small Aneurysm Trial. Therefore, treatment of associated cardiovascular risk factors is important and may have to be tailored on an individual basis according to the findings of the arterial wall mechanics.
腹主动脉瘤（AAA）患者的主动脉和颈动脉僵硬度升高。外周血管疾病（PVD）常与AAA并存，可能进一步损害动脉壁力学并增加心血管负荷。因此，我们研究了这组患者的弹性颈动脉和肌性股动脉的生物力学特性及内膜中层厚度（IMT）。
使用配备壁跟踪系统的双功扫描仪，测定30例AAA患者（15例合并PVD）的颈总动脉和股总动脉的弹性指数及IMT。还评估了空腹血浆肌酐水平、血糖和血脂浓度，以及已知影响动脉壁力学的生理变量。
合并PVD的AAA患者的颈动脉（彼得森弹性模量，2207±905 mmHg对1268±432 mmHg；P = 0.001；僵硬度指数，22.73±9.63对12.60±4.24；P = 0.001）和股动脉（彼得森弹性模量，4906±4057 mmHg对2599±1169 mmHg；P = 0.043；僵硬度指数，49.02±40.04对26.07±13.22；P = 0.044）比单纯AAA患者明显更僵硬。虽然合并PVD的患者颈动脉和股动脉的IMT更厚，但两组之间无统计学差异。受试者在年龄、体重指数、心率、收缩压和舒张压、总血管风险评分、血浆肌酐水平以及空腹血脂和血糖浓度方面进行了匹配。
合并PVD和AAA的受试者的颈动脉和股动脉明显更僵硬，这可能表明心血管负荷增加，并且可能是英国小动脉瘤试验中这些患者最高死亡率的原因。因此，治疗相关的心血管危险因素很重要，可能必须根据动脉壁力学的研究结果进行个体化调整。
