总管腔容积预测血管内动脉瘤修复术后的风险。
Total Luminal Volume Predicts Risk after Endovascular Aneurysm Repair.
机构信息
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Angiology and Vascular Surgery, Centro Hospitalar São João, Porto, Portugal; Department of Surgery and Physiology, Faculdade de Medicina da Univesidade do Porto, Porto, Portugal.
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Angiology and Vascular Surgery, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisbon, Portugal; NOVA Medical School, Lisbon, Portugal.
出版信息
Eur J Vasc Endovasc Surg. 2020 Jun;59(6):918-927. doi: 10.1016/j.ejvs.2020.02.011. Epub 2020 Mar 18.
OBJECTIVE
Large aneurysm diameter represents a well known predictor of late complications after endovascular aneurysm repair (EVAR). However, the role of the thrombus free lumen inside the abdominal aortic aneurysm (AAA) sac is not clear. It was hypothesised that greater luminal volume represents a relevant risk factor for late complications after EVAR.
METHODS
A retrospective cohort analysis was performed including all patients undergoing EVAR from 2005 to 2016 at a tertiary referral institution. Pre-operative AAA lumen volume was measured in centre lumen line reconstructions and patients were stratified into quartiles according to luminal volume. The primary endpoint was freedom from AAA related complications. Secondary endpoints were freedom from neck events (type 1A endoleak, migration >5 mm or any pre-emptive neck related intervention), iliac related events (type 1B endoleak or pre-emptive iliac related intervention), and overall survival.
RESULTS
Four hundred and four patients were included: 101 in the first quartile (Q1; <61 cm). Patients with higher luminal volumes had wider, shorter, and more angulated proximal necks. There were more ruptured AAAs, more aorto-uni-iliac implanted devices and patients outside neck instructions for use in the 4th quartile. Five year freedom from AAA related complications was 79%, 66%, 58% and 56%, respectively (p = .007). At five years, freedom from neck related events was 86%, 84%, 73%, and 71%, respectively, for the four groups (p = .009), and freedom from iliac related events was 96%, 91%, 88%, and 88%, respectively (p = .335). On multivariable analysis, luminal volume was an independent predictor of late complications (Q4 vs. Q1 - hazard ratio: 1.91, 95% confidence interval 1.01-3.6, p = .046). Overall survival at five years was not affected by lumen volume (p = .75).
CONCLUSION
AAA luminal volume represents an important risk factor for AAA related complications. This information may be considered when deciding tailoring surveillance protocols after EVAR. However, larger studies are needed to validate this hypothesis.
目的
大的动脉瘤直径是血管内动脉瘤修复（EVAR）后晚期并发症的一个已知预测因子。然而，腹主动脉瘤（AAA）囊内血栓自由腔的作用尚不清楚。有人假设，更大的管腔容积是 EVAR 后晚期并发症的一个相关危险因素。
方法
对 2005 年至 2016 年在一家三级转诊机构接受 EVAR 的所有患者进行了回顾性队列分析。在中心管腔线重建中测量术前 AAA 管腔容积，并根据管腔容积将患者分为四分位数。主要终点是无 AAA 相关并发症。次要终点是无颈部事件（1A 型内漏、迁移>5mm 或任何预防性颈部相关干预）、髂相关事件（1B 型内漏或预防性髂相关干预）和总生存。
结果
共纳入 404 例患者：第 1 四分位数（Q1；<61cm）101 例。管腔容积较大的患者，近端颈部更宽、更短、更弯曲。第 4 四分位数患者中，AAA 破裂更多，主动脉-单-髂植入装置更多，且患者超出颈部使用说明。AAA 相关并发症的 5 年无复发率分别为 79%、66%、58%和 56%（p=0.007）。5 年时，各组的颈部相关事件无复发率分别为 86%、84%、73%和 71%（p=0.009），髂相关事件无复发率分别为 96%、91%、88%和 88%（p=0.335）。多变量分析显示，管腔容积是晚期并发症的独立预测因子（Q4 与 Q1 相比-风险比：1.91，95%置信区间 1.01-3.6，p=0.046）。5 年总生存率不受管腔容积影响（p=0.75）。
结论
AAA 管腔容积是 AAA 相关并发症的重要危险因素。在决定 EVAR 后定制监测方案时，可以考虑这些信息。然而，需要更大的研究来验证这一假设。
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