Png Chien Yi M, Tadros Rami O, Kang Ming, Beckerman William E, Tardiff Melissa L, Vouyouka Ageliki G, Marin Michael L, Faries Peter L
Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Ann Vasc Surg. 2017 Aug;43:65-72. doi: 10.1016/j.avsg.2016.10.059. Epub 2017 Mar 14.
This study aims to investigate the effect of diabetes on post-endovascular aneurysm repairs (EVARs) of abdominal aortic aneurysms (AAAs).
A total of 1,479 consecutive patients who underwent AAA EVAR were reviewed. The cohorts were divided based on their diabetes status and compared. Preoperative demographic and comorbidity data were analyzed using the t-test and chi-squared test, whereas post-EVAR outcomes were analyzed using Probit multivariate model, followed by Kaplan-Meier survival curve and Cox regression.
Of our 1,479 patients, 993 met inclusion criteria. One hundred eighty-three were diabetics (18.4%) compared with 810 nondiabetics (81.6%). Coronary artery disease (CAD; diabetics: 70.49%, nondiabetics: 60.76%, P = 0.014) and hypertension (HTN; diabetics: 90.16%, nondiabetics: 79.46%, P = 0.0008) were the only comorbidities analyzed, including follow-up length, which had any significant differences between the diabetic and nondiabetic groups. Probit multivariate analysis using a combined cohort follow-up mean of 51 months showed a significant decrease in aneurysm sac enlargement in diabetic patients (diabetics: 13.11%, nondiabetics: 19.43%, model estimate: 0.3058; 95% confidence interval [CI]: 0.0486-0.5629, Pr > ChiSq = 0.0198) and trended toward significantly fewer reinterventions (diabetics: 23.50%, nondiabetics: 28.41%, model estimate: 0.1990; 95% CI: -0.0262 to 0.4243, Pr > ChiSq = 0.0833). In the Cox regressions, diabetes had a significant protective factor on reinterventions (hazard ratio [HR]: 0.697, Pr > ChiSq = 0.0151), and was trending toward significance for aneurysm sac enlargement (HR: 0.750, Pr > ChiSq = 0.1961). There was no significant difference across diabetic status in any other outcomes, including mortality and endoleak occurrence.
Although a higher proportion of diabetic patients present with HTN and CAD, they have decreased long-term rates of aneurysm sac enlargement after EVAR. As a result, this cohort trends toward a lower need for reintervention after EVAR.
本研究旨在调查糖尿病对腹主动脉瘤（AAA）血管腔内修复术（EVAR）后效果的影响。
回顾了1479例连续接受AAA-EVAR手术的患者。根据糖尿病状态对队列进行分组并比较。术前人口统计学和合并症数据采用t检验和卡方检验进行分析，而EVAR术后结果采用概率多元模型分析，随后进行Kaplan-Meier生存曲线和Cox回归分析。
在我们的1479例患者中，993例符合纳入标准。其中183例为糖尿病患者（18.4%），810例为非糖尿病患者（81.6%）。仅分析了冠状动脉疾病（CAD；糖尿病患者：70.49%，非糖尿病患者：60.76%，P = 0.014）和高血压（HTN；糖尿病患者：90.16%，非糖尿病患者：79.46%，P = 0.0008）这两种合并症，包括随访时长，糖尿病组和非糖尿病组之间存在显著差异。对合并队列进行平均51个月的随访后，概率多元分析显示糖尿病患者的瘤囊增大显著减少（糖尿病患者：13.11%，非糖尿病患者：19.43%，模型估计值：0.3058；95%置信区间[CI]：0.0486 - 0.5629，Pr>ChiSq = 0.0198），再次干预的趋势也显著减少（糖尿病患者：23.50%，非糖尿病患者：28.41%，模型估计值：0.1990；95% CI：-0.0262至0.4243，Pr>ChiSq = 0.0833）。在Cox回归分析中，糖尿病对再次干预有显著保护作用（风险比[HR]：0.697，Pr>ChiSq = 0.0151），对瘤囊增大也有显著趋势（HR：0.750，Pr>ChiSq = 0.1961）。在包括死亡率和内漏发生在内的任何其他结果方面，糖尿病状态之间没有显著差异。
尽管糖尿病患者中高血压和CAD的比例较高，但他们在EVAR术后瘤囊增大的长期发生率较低。因此，该队列在EVAR术后再次干预的需求趋势较低。
