Department of Clinical Physiology, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Eur J Vasc Endovasc Surg. 2020 Nov;60(5):739-746. doi: 10.1016/j.ejvs.2020.07.009. Epub 2020 Aug 7.
Abdominal aortic aneurysm (AAA) is associated with morphological and functional changes in both aneurysmal and non-aneurysmal arteries. However, it remains uncertain whether similar changes also exist in the venous vasculature. The aim of this study was to evaluate global venous function in patients with AAA and controls.
This experimental study comprised 31 men with AAA (mean ± standard deviation age 70.0 ± 2.8 years) and 29 male controls (aged 70.6 ± 3.4 years). Venous occlusion plethysmography (VOP) was used to evaluate arm venous compliance at venous pressures between 10 and 60 mmHg in steps of 5 mmHg. Compensatory mobilisation of venous capacitance blood (capacitance response) was measured with a volumetric technique during experimental hypovolaemia induced by lower body negative pressure (LBNP).
The VOP induced pressure-volume curve was significantly less steep in patients with AAA (interaction, p < .001), indicating lower venous compliance. Accordingly, the corresponding pressure-compliance curves displayed reduced venous compliance at lower venous pressures in patients with AAA vs. controls (interaction, p < .001; AAA vs. control, p = .018). After adjusting for arterial hypertension, diabetes mellitus, hyperlipidaemia, chronic obstructive pulmonary disease, and smoking, VOP detected differences in venous compliance remained significant at low venous pressures, that is, at 10 mmHg (p = .008), 15 mmHg (p = .013), and 20 mmHg (p = .026). Mean venous compliance was negatively correlated with aortic diameter (r = -.332, p = .010). Mobilisation of venous capacitance response during LBNP was reduced by approximately 25% in patients with AAA (p = .030), and the redistribution of venous blood during LBNP was negatively correlated with aortic diameter (r = -.417, p = .007).
Men with AAA demonstrated reduced venous compliance and, as a result, a lesser capacity to mobilise peripheral venous blood to the central circulation during hypovolaemic stress. These findings imply that the AAA disease may be accompanied by functional changes in the venous vascular wall.
腹主动脉瘤（AAA）与动脉瘤和非动脉瘤动脉的形态和功能变化相关。然而，尚不确定类似的变化是否也存在于静脉血管系统中。本研究旨在评估 AAA 患者和对照组的整体静脉功能。
本实验研究纳入了 31 名男性 AAA 患者（平均年龄 70.0 ± 2.8 岁）和 29 名男性对照组（平均年龄 70.6 ± 3.4 岁）。使用静脉闭塞体积描记法（VOP）在静脉压力为 10 至 60mmHg 之间以 5mmHg 的步长评估手臂静脉顺应性。通过下体负压（LBNP）诱导的实验性低血容量期间使用容积技术测量静脉容量血液的代偿性动员（容量反应）。
AAA 患者的 VOP 诱导压力-容积曲线明显较平缓（交互作用，p<0.001），表明静脉顺应性降低。相应地，在 AAA 患者与对照组中，较低静脉压力下的相应压力-顺应性曲线显示出较低的静脉顺应性（交互作用，p<0.001；AAA 患者 vs. 对照组，p=0.018）。在校正动脉高血压、糖尿病、高脂血症、慢性阻塞性肺疾病和吸烟后，在较低静脉压力下，VOP 检测到的静脉顺应性差异仍然显著，即 10mmHg（p=0.008）、15mmHg（p=0.013）和 20mmHg（p=0.026）。平均静脉顺应性与主动脉直径呈负相关（r=-0.332，p=0.010）。AAA 患者的 LBNP 期间静脉容量反应的动员减少了约 25%（p=0.030），并且 LBNP 期间静脉血液的再分布与主动脉直径呈负相关（r=-0.417，p=0.007）。
AAA 男性患者表现出静脉顺应性降低，因此在低血容量应激期间，外周静脉血液向中心循环的动员能力降低。这些发现表明，AAA 疾病可能伴有静脉血管壁的功能变化。
