Young Zane Z, Balceniuk Mark D, Rasheed Khurram, Mix Doran, Esce Antoinette, Ellis Jennifer L, Glocker Roan J, Doyle Adam J, Raman Kathleen, Stoner Michael C
1 Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY, USA.
Vasc Endovascular Surg. 2019 May;53(4):292-296. doi: 10.1177/1538574419828083. Epub 2019 Feb 4.
Anatomic severity grade (ASG) can be used to assess abdominal aortic aneurysm (AAA) anatomic complexity. High ASG is associated with complications following endovascular repair of AAAs and we have demonstrated that ASG correlates with resource utilization. The hypothesis of this study is that ASG is directly related to midterm mortality in patients undergoing AAA repair.
Patients who underwent infrarenal AAA repairs between July 2007 and August 2014 were retrospectively reviewed and ASG scores were calculated using 3-dimensional computed tomography reconstructions. Perioperative mortalities (≤30 days) were excluded. The ASG value of 15 was chosen based on previous receiver-operator curve analysis, which showed that an ASG of 15 was predictive of postoperative complications and resource utilization. The 5-year survivors and mortalities were compared utilizing comorbidities, pharmacologic variables, and anatomic variables at or above the defined threshold.
A total of 402 patients (80% male and 96% Caucasian) with complete anatomic and survival data were included in the analysis. Mean ASG and age at the time of repair were 16 ± 0.15 and 73 ± 0.43 years old, respectively. The 5-year mortality was significantly associated with ASG >15 (hazard ratio [HR]: 1.504, confidence interval [CI]: 1.077-2.100, P < .017), hyperlipidemia (HR: 1.987, CI: 1.341-2.946, P < .001), coronary artery disease (HR: 1.432, CI: 1.037-1.978, P < .029), and chronic obstructive pulmonary disease (HR: 1.412, CI: 1.027-1.943, P < .034). Kaplan-Meier analysis demonstrated improved survival in the low score ASG ≤15 group at 1, 3, and 5 years (96% vs 93%, 81% vs 69%, and 53% vs 41%; P = .0182; Figure 1).
Increasing aortic anatomic complexity as characterized by ASG >15 is an independent predictor of midterm mortality following elective infrarenal AAA repair. Therefore, it may be a useful tool for appropriate patient selection and risk stratification prior to elective infrarenal AAA repair.
解剖严重程度分级（ASG）可用于评估腹主动脉瘤（AAA）的解剖复杂性。高ASG与AAA血管内修复术后的并发症相关，并且我们已经证明ASG与资源利用相关。本研究的假设是ASG与接受AAA修复患者的中期死亡率直接相关。
回顾性分析2007年7月至2014年8月间接受肾下AAA修复的患者，并使用三维计算机断层扫描重建计算ASG评分。排除围手术期死亡率（≤30天）。基于先前的受试者工作特征曲线分析选择ASG值为15，该分析表明ASG为15可预测术后并发症和资源利用。利用定义阈值或以上的合并症、药理学变量和解剖学变量比较5年幸存者和死亡者。
共有402例患者（80%为男性，96%为白种人）纳入分析，其具有完整的解剖学和生存数据。修复时的平均ASG和年龄分别为16±0.15和73±0.43岁。5年死亡率与ASG>15（风险比[HR]：1.504，置信区间[CI]：1.077 - 2.100，P <.017）、高脂血症（HR：1.987，CI：1.341 - 2.946，P <.001）、冠状动脉疾病（HR：1.432，CI：1.037 - 1.978，P <.029）和慢性阻塞性肺疾病（HR：1.412，CI：1.027 - 1.943，P <.034）显著相关。Kaplan-Meier分析显示，ASG≤15的低分组在1年、3年和5年时生存率提高（96%对93%，81%对69%，53%对41%；P =.0182；图）。
以ASG>15为特征的主动脉解剖复杂性增加是择期肾下AAA修复术后中期死亡率的独立预测因素。因此，它可能是择期肾下AAA修复术前合适患者选择和风险分层的有用工具。
