Timaran Carlos H, Rosero Eric B, Smith Stephen T, Modrall J Gregory, Valentine R James, Clagett G Patrick
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, and Dallas Veterans Affairs Medical Center, Dallas, Texas 75390-9157, USA.
Ann Vasc Surg. 2008 Nov;22(6):730-5. doi: 10.1016/j.avsg.2008.08.034. Epub 2008 Oct 1.
Prior to approval by the U.S. Food and Drug Administration of larger endografts (main body diameters up to 36 mm), small abdominal aortic aneurysms (AAAs, <5.5 cm) were shown to be more suitable for endovascular repair (EVAR) than large AAAs (> or =5.5 cm). The purpose of this study was to assess changes in EVAR suitability with the potential use of larger endografts in unselected consecutive patients. The influence of age, aneurysm size, and patient fitness on EVAR suitability was also assessed. We studied 186 male patients referred for evaluation of nonruptured AAAs who underwent contrast-enhanced computed tomographic scans with three-dimensional reconstructions. Morphologicall AAA features and neck characteristics were measured according to Society for Vascular Surgery reporting standards to determine EVAR suitability. Patient fitness for repair was assessed using the customized probability index, a validated fitness score for vascular surgery procedures. Suitability for EVAR was determined by neck anatomy, iliac artery morphology, and total aortic aneurysm angulation and tortuosity according to the clinicians' experience and current practice. The median age of the study cohort was 72 years (interquartile range [IQR] 65-79 years). The median maximum AAA diameter was 5.4 cm (IQR 4.1-5.9). Median fitness score was +7 (IQR -7 to +14). EVAR suitability for large AAAs significantly increased with larger endografts (35-63%, p<0.001). Changes in EVAR suitability for small AAAs were not significant (69-75%, p=0.06). Maximum AAA diameter was not an independent predictor for EVAR suitability with larger endografts after adjusting for neck anatomy. Aortic neck length (odds ratio [OR]=1.2, 95% confidence interval [CI] 1.1-1.2) and diameter (OR=0.78, 95% CI 0.63-0.96) were the only independent predictors for EVAR suitability with larger endografts. Age, AAA size, and fitness did not differ between patients suitable and unsuitable for EVAR with larger endografts. In conclusion, introduction of larger endografts (up to 36 mm in main body diameter) in the United States has resulted in significantly increased anatomic suitability for EVAR for large AAAs. Conversely, suitability has not significantly changed for small AAAs. Overall, EVAR suitability is not influenced by age, aneurysm size, or patient fitness.
在美国食品药品监督管理局批准更大尺寸的腔内移植物（主体直径达36mm）之前，小型腹主动脉瘤（AAA，<5.5cm）被证明比大型AAA（≥5.5cm）更适合进行血管腔内修复（EVAR）。本研究的目的是评估在未选择的连续患者中使用更大尺寸腔内移植物对EVAR适用性的影响。同时还评估了年龄、动脉瘤大小和患者健康状况对EVAR适用性的影响。我们研究了186例因未破裂AAA前来评估的男性患者，这些患者均接受了三维重建的增强CT扫描。根据血管外科学会报告标准测量AAA的形态特征和颈部特征，以确定EVAR的适用性。使用定制概率指数评估患者的修复健康状况，该指数是一种经过验证的血管外科手术健康评分。根据临床医生的经验和当前实践，通过颈部解剖结构、髂动脉形态以及腹主动脉瘤的总角度和迂曲度来确定EVAR的适用性。研究队列的中位年龄为72岁（四分位间距[IQR]65 - 79岁）。AAA的最大直径中位数为5.4cm（IQR 4.1 - 5.9）。健康评分中位数为 +7（IQR -7至 +14）。随着腔内移植物尺寸增大，大型AAA的EVAR适用性显著增加（35 - 63%，p<0.001）。小型AAA的EVAR适用性变化不显著（69 - 75%，p = 0.06）。在调整颈部解剖结构后，AAA最大直径并非更大尺寸腔内移植物EVAR适用性的独立预测因素。主动脉颈部长度（比值比[OR]=1.2，95%置信区间[CI]1.1 - 1.2）和直径（OR=0.78，95% CI 0.63 - 0.96）是更大尺寸腔内移植物EVAR适用性的仅有的独立预测因素。对于适合和不适合使用更大尺寸腔内移植物进行EVAR的患者，年龄、AAA大小和健康状况并无差异。总之，在美国引入更大尺寸的腔内移植物（主体直径达36mm）已使大型AAA进行EVAR的解剖学适用性显著增加。相反，小型AAA的适用性并未显著改变。总体而言，EVAR适用性不受年龄、动脉瘤大小或患者健康状况的影响。
