Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Thyroid and Vascular Surgery, Qingdao Eighth People's Hospital, Qingdao, China.
Ann Vasc Surg. 2021 Oct;76:302-308. doi: 10.1016/j.avsg.2021.03.041. Epub 2021 Apr 24.
Endoleaks may be present in up to 25% of patients after endovascular abdominal aortic aneurysm repair (EVAR) and there is no clear consensus on valuable biomarkers to determine endoleak presence. The aim of this study was to examine the potential value of plasma tumor necrosis factor-α converting enzyme (TACE) and Notch1 concentrations in determining endoleak presence after EVAR.
A total of 110 patients with abdominal aortic aneurysm who underwent EVAR were enrolled in our study, and plasma TACE and Notch1 concentrations were measured prior to and 6 months after EVAR. Logistic regression was performed to assess the association of postoperative plasma TACE and Notch1 concentrations with endoleak after adjusting for potential confounders. The ability of plasma TACE and Notch1 concentrations to determine endoleak presence was assessed using receiver operating characteristic curves and area under the curve (AUC).
Twenty-four patients developed endoleaks 6 months after EVAR. Both postoperative plasma TACE and Notch1 concentrations were higher in patients with endoleak than in those without endoleak (2376.4 ± 28.1 pg/ml vs. 2094.1 ± 27.3 pg/ml, P < 0.01; 218.6 ± 1.9 pg/ml vs. 195.0 ± 2.1 pg/ml, P < 0.01, respectively). The AUCs from receiver operating characteristic curve analysis of plasma TACE and Notch1 concentrations in determining endoleak presence were 0.844 (95% CI 0.771 to 0.918, P < 0.01) and 0.860 (95% CI 0.791 to 0.930, P < 0.01), respectively. Combining the detection of plasma Notch1 and TACE concentrations could improve the accuracy in determining endoleak presence (AUC 0.930, 95% CI 0.883 to 0.978, P < 0.01). The predicted probability cutoff of 0.22 yielded a sensitivity of 95.8% and a specificity of 82.6% for endoleak presence.
Plasma TACE and Notch1 levels can discriminate patients with and without endoleak 6 months after EVAR, and have a potential role in screening patients requiring computed tomography angiography.
血管内腹主动脉瘤修复（EVAR）后，多达 25%的患者可能存在内漏，目前尚无明确共识认为哪种生物标志物具有价值，能够确定内漏的存在。本研究旨在探讨血浆肿瘤坏死因子-α转化酶（TACE）和 Notch1 浓度在确定 EVAR 后内漏存在的潜在价值。
共纳入 110 例接受 EVAR 的腹主动脉瘤患者，在 EVAR 前后测量血浆 TACE 和 Notch1 浓度。采用逻辑回归分析，调整潜在混杂因素后，评估术后血浆 TACE 和 Notch1 浓度与 EVAR 后内漏的关系。采用受试者工作特征曲线和曲线下面积（AUC）评估血浆 TACE 和 Notch1 浓度确定内漏存在的能力。
EVAR 后 6 个月，24 例患者发生内漏。与无内漏患者相比，有内漏患者术后血浆 TACE 和 Notch1 浓度更高（2376.4±28.1 pg/ml 比 2094.1±27.3 pg/ml，P<0.01；218.6±1.9 pg/ml 比 195.0±2.1 pg/ml，P<0.01）。血浆 TACE 和 Notch1 浓度判断内漏存在的受试者工作特征曲线分析 AUC 分别为 0.844（95%CI 0.771 至 0.918，P<0.01）和 0.860（95%CI 0.791 至 0.930，P<0.01）。联合检测血浆 Notch1 和 TACE 浓度可提高判断内漏存在的准确性（AUC 0.930，95%CI 0.883 至 0.978，P<0.01）。预测概率截断值为 0.22 时，内漏存在的敏感性为 95.8%，特异性为 82.6%。
EVAR 后 6 个月，血浆 TACE 和 Notch1 水平可区分有内漏和无内漏患者，对 CT 血管造影有潜在的筛查作用。
