Diehm Nicolas, Hobo Roel, Baumgartner Iris, Do Dai-Do, Keo Hak-Hong, Kalka Christoph, Dick Florian, Buth Jaap, Schmidli Juerg
Division of Angiology, Swiss Cardiovascular Centre, University Hospital, (Inselspital), Bern, Switzerland.
J Endovasc Ther. 2007 Apr;14(2):122-9. doi: 10.1177/152660280701400202.
To elucidate the association of impaired pulmonary status (IPS) and diabetes mellitus (DM) with clinical outcome and the incidences of aortic neck dilatation and type I endoleak after elective endovascular infrarenal aortic aneurysm repair (EVAR).
In 164 European institutions participating in the EUROSTAR registry, 6383 patients (5985 men; mean age 72.4+/-7.6 years) underwent EVAR. Patients were divided into patients without versus with IPS or with/without DM. Clinical assessment and contrast-enhanced computed tomography (CT) were performed at 1, 3, 6, 12, 18, and 24 months and annually thereafter. Cumulative endpoint analysis comprised death, aortic rupture, type I endoleak, endovascular reintervention, and surgical conversion.
Prevalence of IPS was 2733/6383 (43%) and prevalence of DM was 810/6383 (13%). Mean follow-up was 21.1+/-18.4 months. Thirty-day mortality, AAA rupture, and conversion rates did not differ between patients with versus without IPS and between patients with versus without DM. All-cause and AAA-related mortality, respectively, were significantly higher in patients with IPS compared to patients with normal pulmonary status (31.0% versus 19.0%, p<0.0001 and 6.8% versus 3.3%, p = 0.0057) throughout follow-up. In multivariate analysis adjusted for smoking, age, gender, comorbidities, fitness for open repair, co-existing common iliac aneurysm, neck and aneurysm size, arterial angulations, aneurysm classification, endograft oversizing >or=15%, and type of stent-graft, the presence of IPS was not associated with significantly higher rates of aortic neck dilatation (30.6% versus 38.0%, p>0.05) and did not influence cumulative rates of type I endoleak, endovascular reintervention, or conversion to open surgery (p>0.05). Similarly, the presence of DM did not influence the above-mentioned study endpoints.
In contrast to observations regarding the natural course of AAAs, impaired pulmonary status does not negatively influence aortic neck dilatation, while the presence of diabetes does not protect from these dismal events after EVAR.
阐明肺功能受损（IPS）和糖尿病（DM）与临床结局以及选择性肾下腹主动脉瘤腔内修复术（EVAR）后主动脉颈部扩张和I型内漏发生率之间的关联。
在参与EUROSTAR注册研究的164家欧洲机构中，6383例患者（5985例男性；平均年龄72.4±7.6岁）接受了EVAR治疗。患者被分为无IPS组与有IPS组或有/无DM组。在术后1、3、6、12、18和24个月以及此后每年进行临床评估和增强计算机断层扫描（CT）。累积终点分析包括死亡、主动脉破裂、I型内漏、腔内再次干预和转为开放手术。
IPS的患病率为2733/6383（43%），DM的患病率为810/6383（13%）。平均随访时间为21.1±18.4个月。有IPS与无IPS的患者以及有DM与无DM的患者之间，30天死亡率、腹主动脉瘤破裂率和转换率无差异。在整个随访期间，与肺功能正常的患者相比，IPS患者的全因死亡率和与腹主动脉瘤相关的死亡率分别显著更高（31.0%对19.0%，p<0.0001；6.8%对3.3%，p = 0.0057）。在对吸烟、年龄、性别、合并症、开放修复的适宜性、并存的髂总动脉瘤、颈部和动脉瘤大小、动脉成角、动脉瘤分类、移植物尺寸过大≥15%以及支架移植物类型进行多变量分析调整后，IPS的存在与主动脉颈部扩张率显著升高无关（30.6%对38.0%，p>0.05），并且不影响I型内漏、腔内再次干预或转为开放手术的累积发生率（p>0.05）。同样，DM的存在也不影响上述研究终点。
与关于腹主动脉瘤自然病程的观察结果相反，肺功能受损不会对主动脉颈部扩张产生负面影响，而糖尿病的存在并不能预防EVAR后这些不良事件。
