动脉瘤囊血栓体积可预测血管内动脉瘤修复术后Ⅱ型内漏导致的动脉瘤扩大。
Aneurysm Sac Thrombus Volume Predicts Aneurysm Expansion with Type II Endoleak After Endovascular Aneurysm Repair.
作者信息
Fujii Takayuki, Banno Hiroshi, Kodama Akio, Sugimoto Masayuki, Akita Naohiro, Tsuruoka Takuya, Sakakibara Masashi, Komori Kimihiro
机构信息
Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
出版信息
Ann Vasc Surg. 2020 Jul;66:85-94.e1. doi: 10.1016/j.avsg.2019.11.045. Epub 2019 Dec 18.
BACKGROUND
Several studies have analyzed risk factors that may influence the incidence of type II endoleak with sac expansion after endovascular aneurysm repair (EVAR). However, the impact of intraluminal thrombus volume on the incidence of sac expansion with type II endoleak requires further analysis. This study examined the correlation between preoperative intraluminal thrombus and the incidence of type II endoleak and late sac expansion by measuring the thrombus volume.
METHODS
Between June 2007 and March 2014, 423 patients underwent EVAR at our institution. Two hundred and eighty patients with preoperative and postoperative computed tomography angiography (CTA) were included in this study. Data were collected prospectively and supplemented with a retrospective review of the medical records and radiologic images, and demographic and clinical characteristic profiles were collected. Logistic regression and Cox regression analyses were used to assess each variable's association with the incidences of persistent or new endoleak and sac expansion.
RESULTS
Of the 280 patients, 46.7% (131 patients) had persistent type II endoleak, and 19.6% (55 patients) had persistent type II endoleak with significant sac expansion (≥5 mm). The mean follow-up duration was 60 months (interquartile range, 24-72 months). Cox regression analysis showed that older age (P = 0.001), intraluminal thrombus volume ratio (thrombus volume [T vol]/aortic aneurysm volume [A vol]) (P = 0.042) and IMA diameter (P = 0.004) were significant predictors of the incidence of sac expansion with persistent or new type II endoleak. The receiver operating characteristic curve analysis revealed a cutoff of 51% T vol/A vol (area under the curve [AUC]: 0.59) and 2.9 mm (area under the curve [AUC]: 0.60). The rate of freedom from sac expansion (≥5 mm) during followup was significantly higher in patients with ≥51% T vol/A vol than in those with a lower T vol/A vol (P = 0.010).
CONCLUSIONS
Preoperative sac thrombus volume, IMA diameter, and older age predict the incidence of aneurysm expansion with type II endoleak after EVAR.
背景
多项研究分析了可能影响血管内动脉瘤修复术（EVAR）后Ⅱ型内漏伴瘤腔扩张发生率的危险因素。然而，腔内血栓体积对Ⅱ型内漏伴瘤腔扩张发生率的影响需要进一步分析。本研究通过测量血栓体积，探讨术前腔内血栓与Ⅱ型内漏发生率及晚期瘤腔扩张之间的相关性。
方法
2007年6月至2014年3月期间，423例患者在本机构接受了EVAR治疗。本研究纳入了280例术前行计算机断层扫描血管造影（CTA）及术后行CTA的患者。前瞻性收集数据，并对病历和影像学图像进行回顾性补充，同时收集人口统计学和临床特征资料。采用逻辑回归和Cox回归分析评估各变量与持续性或新发内漏及瘤腔扩张发生率的相关性。
结果
280例患者中，46.7%（131例）存在持续性Ⅱ型内漏，19.6%（55例）存在持续性Ⅱ型内漏且瘤腔有显著扩张（≥5mm）。平均随访时间为60个月（四分位间距，24 - 72个月）。Cox回归分析显示，年龄较大（P = 0.001）、腔内血栓体积比（血栓体积[T vol]/腹主动脉瘤体积[A vol]）（P = 0.042）和肠系膜下动脉（IMA）直径（P = 0.004）是持续性或新发Ⅱ型内漏伴瘤腔扩张发生率的显著预测因素。受试者工作特征曲线分析显示，T vol/A vol的截断值为51%（曲线下面积[AUC]：0.59），IMA直径的截断值为2.9mm（曲线下面积[AUC]：0.60）。随访期间，T vol/A vol≥51%的患者瘤腔扩张（≥5mm）的无进展率显著高于T vol/A vol较低的患者（P = 0.010）。
结论
术前瘤腔内血栓体积、IMA直径和年龄较大可预测EVAR术后Ⅱ型内漏伴动脉瘤扩张的发生率。
Zotero 插件