Department of Surgery, Keio University School of Medicine, Tokyo, Japan; Division of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan.
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
J Vasc Surg. 2018 May;67(5):1410-1418.e1. doi: 10.1016/j.jvs.2017.08.076.
The applicability of early sac shrinkage as a predictor of a low risk of late complications after endovascular aneurysm repair (EVAR) in Asian populations has not been validated. This study aimed to analyze early sac shrinkage and its relationship with late complications in Asian people using a Japanese multicenter database. We also assessed the impact of endoleaks.
A retrospective analysis of 697 patients who had undergone EVAR of abdominal aortic aneurysms from 2008 to 2015 and were followed up for at least 1 year was conducted. Late complications were defined as any aneurysm-related events occurring >1 year after EVAR, including >5-mm aneurysm sac enlargements and any reinterventions performed. Endoleaks without any evidence of sac enlargement or a requirement for additional treatment were not considered late complications.
Early sac shrinkage, defined as a >5-mm-diameter decrease within 1 year of EVAR, occurred in 335 patients (48.1%); type I endoleaks (T1ELs) and isolated type II endoleaks (iT2ELs; type II endoleaks without evidence of other endoleaks) were observed in 4.0% and 29.4%, respectively. During the mean follow-up period of 45.5 months, 93 late complications (13.3%) occurred. Kaplan-Meier curve and log-rank analyses showed that early sac shrinkage was a significant predictor for a lower risk of late complications (P < .001). Multivariate analysis revealed that early sac shrinkage was independently associated with a lower risk of late complications (adjusted hazard ratio, 0.425; P = .004). Conversely, T1ELs and iT2ELs were positively associated with late complication (adjusted hazard ratio, 11.774 and 5.137, respectively; both P < .001). Subsequent multivariate analysis demonstrated that T1ELs and iT2ELs were negatively associated with early sac shrinkage (adjusted odds ratio, 0.102 and 0.285, respectively; both P < .001).
Early sac shrinkage was associated with a low risk of late complications in Asian people and may be a good surrogate marker of durable success after EVAR. T1ELs and iT2ELs were negatively associated with early sac shrinkage and positively associated with late complications. Along with the high incidence of iT2ELs observed, T2ELs may be an important condition to consider after EVAR in the Asian population.
早期瘤腔缩小作为血管内动脉瘤修复术（EVAR）后晚期并发症风险低的预测因子，其在亚洲人群中的适用性尚未得到验证。本研究旨在使用日本多中心数据库分析亚洲人群的早期瘤腔缩小及其与晚期并发症的关系。我们还评估了内漏的影响。
对 2008 年至 2015 年间接受腹主动脉瘤 EVAR 治疗且至少随访 1 年的 697 例患者进行回顾性分析。晚期并发症定义为 EVAR 后>1 年发生的任何与动脉瘤相关的事件，包括>5mm 的瘤腔增大和任何再次干预。没有瘤腔增大或需要额外治疗证据的内漏不被认为是晚期并发症。
335 例（48.1%）患者出现早期瘤腔缩小（定义为 EVAR 后 1 年内直径缩小>5mm）；4.0%的患者存在 I 型内漏（T1ELs），29.4%的患者存在孤立型 II 型内漏（无其他内漏证据的 II 型内漏）。在平均 45.5 个月的随访期间，93 例发生晚期并发症（13.3%）。Kaplan-Meier 曲线和对数秩分析显示，早期瘤腔缩小是晚期并发症风险降低的显著预测因子（P<0.001）。多变量分析显示，早期瘤腔缩小与晚期并发症风险降低独立相关（调整后的危险比为 0.425；P=0.004）。相反，T1ELs 和 iT2ELs 与晚期并发症呈正相关（调整后的危险比分别为 11.774 和 5.137；均 P<0.001）。进一步的多变量分析表明，T1ELs 和 iT2ELs 与早期瘤腔缩小呈负相关（调整后的优势比分别为 0.102 和 0.285；均 P<0.001）。
早期瘤腔缩小与亚洲人群晚期并发症风险降低相关，可能是 EVAR 后持久成功的良好替代标志物。T1ELs 和 iT2ELs 与早期瘤腔缩小呈负相关，与晚期并发症呈正相关。鉴于亚洲人群 iT2ELs 的高发生率，T2ELs 可能是 EVAR 后需要考虑的一个重要情况。
