Department of Cardiology, University Medical Centre Utrecht, the Netherlands; Department of Anaesthesiology, University Medical Centre Utrecht, the Netherlands.
Department of Anaesthesiology, University Medical Centre Utrecht, the Netherlands.
Eur J Vasc Endovasc Surg. 2019 Feb;57(2):304-310. doi: 10.1016/j.ejvs.2018.08.054. Epub 2018 Oct 20.
Endovascular aortic repair (EVAR) is associated with an increased risk of pulmonary embolism, which is often clinically silent and therefore difficult to recognise. The aim was to investigate the incidence of pulmonary embolism after EVAR using routinely performed pre- and post-operative aortic computed tomography angiography (CTA), and the association between pulmonary embolism and mortality.
This single centre retrospective cohort study included adult patients who underwent EVAR in the University Medical Centre Utrecht between January 2010 and July 2015 and who had a total aortic, thoracic aortic, or pulmonary CTA within one month post-operatively. Baseline and mortality data were obtained by reviewing hospital and general practitioner records. The primary outcome was pulmonary embolism within one month after surgery. Secondary outcomes were 30 day and six month mortality.
During the study period, 526 EVARs were performed. Seventy-four of these procedures were included in the analysis of which there were 40 thoracic and 34 abdominal EVARs. In nine patients (12%, 95% CI 7-22) pulmonary embolism was observed of which one was central, two were segmental, and six were subsegmental. Seven were clinically silent and two were present on the pre-operative CTA. Thirty day mortality was significantly higher in patients with pulmonary embolism (relative risk 14.4, 95% CI 1.4-143, p = .037) though none of the deaths seemed directly attributable to it.
This study, although preliminary, suggests that silent pulmonary embolism after EVAR occurs in approximately one in 10 patients, despite routine thrombo-embolism prophylaxis. Pulmonary embolism was associated with a higher 30 day mortality risk yet it was not the cause of death in any of these patients.
血管内主动脉修复术（EVAR）与肺栓塞的风险增加相关，而肺栓塞通常在临床上是无症状的，因此难以识别。本研究旨在通过常规进行的术前和术后主动脉计算机断层血管造影（CTA）来调查 EVAR 后肺栓塞的发生率，并研究肺栓塞与死亡率之间的关系。
这项单中心回顾性队列研究纳入了 2010 年 1 月至 2015 年 7 月期间在乌得勒支大学医学中心接受 EVAR 治疗的成年患者，并且这些患者在术后一个月内进行了全主动脉、胸主动脉或肺动脉 CTA。通过查阅医院和全科医生的记录获得基线和死亡率数据。主要结局是术后一个月内发生肺栓塞。次要结局为 30 天和 6 个月死亡率。
在研究期间，共进行了 526 例 EVAR。74 例手术被纳入分析，其中包括 40 例胸主动脉 EVAR 和 34 例腹主动脉 EVAR。在 9 例患者（12%，95%CI 7-22）中观察到肺栓塞，其中 1 例为中央型，2 例为节段型，6 例为亚段型。7 例为临床无症状，2 例为术前 CTA 上存在。肺栓塞患者的 30 天死亡率显著更高（相对风险 14.4，95%CI 1.4-143，p=0.037），尽管这些死亡似乎并非直接由其引起。
尽管初步研究，但本研究表明，尽管常规进行血栓栓塞预防，EVAR 后仍有约 10%的患者会发生无症状性肺栓塞。肺栓塞与更高的 30 天死亡率相关，但在这些患者中均未导致死亡。
