Arko Frank R, Filis Konstantinos A, Seidel Scott A, Gonzalez Jim, Lengle Steve J, Webb Ron, Rhee John, Zarins Christopher K
Division of Vascular Surgery, Department of Surgery, Stanford University Hospital, Stanford, California, USA.
J Endovasc Ther. 2004 Feb;11(1):33-40. doi: 10.1177/152660280401100104.
To determine how many patients with abdominal aortic aneurysms (AAA) meet the anatomical selection criteria for AneuRx stent-graft repair in community hospitals of Northern California.
The records were reviewed of 220 AAA patients (171 men, 49 women) who were considered for endovascular repair by the treating vascular surgeon at 28 community hospitals in Northern California between January and October 2001. Contrast computed tomographic angiography (CTA) and selective arteriography were performed at each institution and reviewed by a centralized, independent image-reading center. Selection criteria determined by the manufacturer and published in the indications for use were applied to each set of imaging studies. The number of patients who met inclusion criteria were recorded, as were the anatomical characteristics of each aneurysm.
The mean aneurysm size in the 220 patients was 55.3 +/- 0.7 mm. Among these patients, 122 (55%) were judged to be candidates for endovascular repair and 98 (45%) were considered ineligible. The primary anatomical reason for ineligibility was a short infrarenal neck in 43 (44%) patients, followed by a large proximal neck diameter (25, 25%), iliac aneurysms (10, 10%), extremely tortuous or calcified neck (7, 7%), iliac occlusion (6, 6%), and small distal aortic bifurcation and accessory renal arteries (5, 5%). Four (4%) patients were classified as non-candidates due to poor quality imaging. There was no difference in aneurysm diameter (54.0 +/- 0.8 versus 57.1 +/- 1.2 mm, p=NS) or age (72.2 +/- 1.2 versus 74.6 +/- 2.2 years, p=NS) between candidates and non-candidates. However, proportionally more men (60%) than women (39%) were eligible for endovascular repair with the AneuRx stent-graft (p<0.05). All 122 patients who were considered candidates for endovascular repair were treated, with successful stent-graft placement achieved in 121 (99%).
Fifty-five percent of patients considered for endovascular AAA repair in community hospitals in Northern California met the anatomical selection criteria for the AneuRx stent-graft. Men appeared to be twice as likely to meet the eligibility requirements as women. Unfavorable infrarenal neck anatomy was the primary exclusion criterion for endovascular repair in this community setting.
确定在北加利福尼亚州社区医院中，有多少腹主动脉瘤（AAA）患者符合AneuRx覆膜支架修复的解剖学选择标准。
回顾了2001年1月至10月期间，北加利福尼亚州28家社区医院的220例AAA患者（171例男性，49例女性）的记录，这些患者被主治血管外科医生考虑进行血管内修复。每家机构均进行了对比计算机断层血管造影（CTA）和选择性动脉造影，并由一个集中的独立影像阅读中心进行评估。将制造商确定并在使用说明书中公布的选择标准应用于每组影像学研究。记录符合纳入标准的患者数量以及每个动脉瘤的解剖特征。
220例患者的动脉瘤平均大小为55.3±0.7mm。在这些患者中，122例（55%）被判定为血管内修复的候选者，98例（45%）被认为不符合条件。不符合条件的主要解剖学原因是肾下颈部短的患者有43例（44%），其次是近端颈部直径大（25例，25%）、髂动脉瘤（10例，10%）、颈部极度迂曲或钙化（7例，7%）、髂动脉闭塞（6例，6%）以及远端主动脉分叉和副肾动脉小（5例，5%）。4例（4%）患者因成像质量差被归类为非候选者。候选者和非候选者之间的动脉瘤直径（54.0±0.8对57.1±1.2mm，p=无统计学意义）或年龄（72.2±1.2对74.6±2.2岁，p=无统计学意义）没有差异。然而，符合AneuRx覆膜支架血管内修复条件的男性比例（60%）高于女性（39%）（p<0.05）。所有122例被认为是血管内修复候选者的患者均接受了治疗，121例（99%）成功置入了覆膜支架。
在北加利福尼亚州社区医院中，考虑进行AAA血管内修复的患者中有55%符合AneuRx覆膜支架的解剖学选择标准。男性符合条件的可能性似乎是女性的两倍。在这个社区环境中，不利的肾下颈部解剖结构是血管内修复的主要排除标准。
