Lalka Stephen G, Dalsing Michael C, Sawchuk Alan P, Cikrit Dolores F, Shafique Shoaib
Division of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Vasc Endovascular Surg. 2005 Jul-Aug;39(4):307-15. doi: 10.1177/153857440503900402.
Since the natural tendency of the aorta is to increase in diameter and tortuosity with age and since abdominal aortic aneurysms (AAAs) increase in diameter and length over time, encroaching on the renal and hypogastric orifices, early repair of AAAs (when > or =4.0 cm) may allow greater applicability of the endovascular option because of more favorable aortoiliac morphology. Patients who present at an older age with larger AAAs should be more likely to be anatomically excluded from endovascular AAA repair. Over a 42-month period, 317 consecutive patients referred with aortoiliac aneurysms (infrarenal AAA > or =4.0 cm) were evaluated by one of the authors (SGL) for endovascular vs open repair based on computed tomography (CT) and angiographic imaging. The 10 anatomic exclusion criteria were those applicable to the Zenith endograft (Cook, Inc), which currently is the most anatomically inclusive of the aortic endografts in commercial use in the United States. Based on their aortoiliac morphology, 212 patients were excluded from endovascular repair and 105 were included as acceptable anatomic candidates. Age, AAA size, and the reason(s) for exclusion were recorded for each patient. By use of Student's t test and logistic and linear regression analyses, the groups were compared by age, AAA size, and age + size. There was no significant difference in patient age or AAA size distribution between the group of patients excluded from endovascular repair based on aortoiliac morphology compared to those who met the inclusion criteria. Patients with small AAAs (4.0-5.4 cm) had similar age distribution as those with large (> or =5.5 cm) AAAs. The majority of patients (87%) were excluded based on proximal aortic neck morphology. The presence of aortoiliac morphology that precludes endovascular repair is independent of patient age or AAA size at presentation. A patient presenting with a small (4.0-5.4 cm) AAA is not more likely to be a candidate for endovascular repair than a patient with a large AAA.
由于随着年龄增长，主动脉直径和迂曲度有自然增加的趋势，且腹主动脉瘤（AAA）直径和长度会随时间增加，侵犯肾动脉和髂内动脉开口，因此AAA早期修复（直径≥4.0 cm时）可能因更有利的腹主动脉-髂动脉形态而使血管内修复方案的适用性更强。年龄较大且AAA较大的患者更有可能在解剖学上被排除在血管内AAA修复之外。在42个月的时间里，一位作者（SGL）根据计算机断层扫描（CT）和血管造影成像，对317例连续转诊的腹主动脉-髂动脉动脉瘤患者（肾下AAA≥4.0 cm）进行了血管内修复与开放修复的评估。10项解剖学排除标准适用于Zenith血管内移植物（Cook公司），该移植物目前是美国商业使用的主动脉血管内移植物中解剖学包容性最强的。根据患者的腹主动脉-髂动脉形态，212例患者被排除在血管内修复之外，105例被纳入可接受的解剖学候选者。记录每位患者的年龄、AAA大小和排除原因。通过使用Student t检验以及逻辑回归和线性回归分析，对两组患者的年龄、AAA大小以及年龄+大小进行比较。基于腹主动脉-髂动脉形态被排除在血管内修复之外的患者组与符合纳入标准的患者组在患者年龄或AAA大小分布上无显著差异。小AAA（4.0 - 5.4 cm）患者与大AAA（≥5.5 cm）患者的年龄分布相似。大多数患者（87%）因近端主动脉颈部形态而被排除。排除血管内修复的腹主动脉-髂动脉形态的存在与患者就诊时的年龄或AAA大小无关。与大AAA患者相比，小AAA（4.0 - 5.4 cm）患者并非更有可能成为血管内修复的候选者。
