Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
J Vasc Surg. 2022 Apr;75(4):1260-1267.e3. doi: 10.1016/j.jvs.2021.09.046. Epub 2021 Oct 14.
Current management of small abdominal aortic aneurysms (AAAs) primarily involves serial imaging surveillance of maximum transverse diameter (MTD) to estimate rupture risk. Other measurements, such as volume and tortuosity, are less well-studied and may help characterize and predict AAA progression. This study evaluated predictors of AAA volume growth and discusses the role of volume in clinical practice.
Subjects from the Non-invasive Treatment of Abdominal Aortic Aneurysm Clinical Trial (baseline AAA MTD, 3.5-5.0 cm) with ≥2 computed tomography scans were included in this study (n = 250). Computed tomography scans were conducted approximately every 6 months over 2 years. MTD, volume, and tortuosity were used to model growth. Univariable and multivariable backwards elimination least squares regressions assessed associations with volume growth.
Baseline MTD accounted for 43% of baseline volume variance (P < .0001). Mean volume growth rate was 10.4 cm/year (standard deviation, 8.8 cm/year) (mean volume change +10.4%). Baseline volume accounted for 30% of volume growth variance; MTD accounted for 13% of volume growth variance. More tortuous aneurysms at baseline had significantly larger volume growth rates (difference, 32.8 cm/year; P < .0001). Univariable analysis identified angiotensin II receptor blocker use (difference, -3.4 cm/year; P = .02) and history of diabetes mellitus (difference, -2.8 cm/year; P = .04) to be associated with lower rates of volume growth. Baseline volume, tortuosity index, current tobacco use, and absence of diabetes mellitus remained significantly associated with volume growth in multivariable analysis. AAAs that reached the MTD threshold for repair had a wide range of volumes: 102 cm to 142 cm in female patients (n = 5) and 105 cm to 229 cm in male patients (n = 20).
Baseline AAA volume and MTD were found to be moderately correlated. On average, AAA volume grows about 10% annually. Baseline volume, tortuosity, MTD, current tobacco use, angiotensin II receptor blocker use, and history of diabetes mellitus were predictive of volume growth over time.
目前，小的腹主动脉瘤（AAA）的主要治疗方法是通过连续影像学监测最大横径（MTD）来估计破裂风险。其他测量方法，如体积和迂曲度，研究较少，可能有助于对 AAA 的进展进行特征描述和预测。本研究评估了 AAA 体积增长的预测因素，并讨论了体积在临床实践中的作用。
本研究纳入了非侵入性治疗腹主动脉瘤临床试验（基线 AAA MTD，3.5-5.0cm）中至少有 2 次计算机断层扫描的患者（n=250）。在 2 年内，大约每 6 个月进行一次计算机断层扫描。使用 MTD、体积和迂曲度来建立生长模型。单变量和多变量向后消除最小二乘回归评估与体积增长的关联。
基线 MTD 解释了基线体积方差的 43%（P<0.0001）。平均体积增长率为 10.4cm/年（标准差为 8.8cm/年）（平均体积变化+10.4%）。基线体积解释了体积增长方差的 30%；MTD 解释了体积增长方差的 13%。基线时迂曲度更大的动脉瘤体积增长率明显更大（差异为 32.8cm/年；P<0.0001）。单变量分析发现，血管紧张素 II 受体阻滞剂的使用（差异为-3.4cm/年；P=0.02）和糖尿病史（差异为-2.8cm/年；P=0.04）与体积增长率较低有关。多变量分析中，基线体积、迂曲指数、当前吸烟和无糖尿病史与体积增长仍显著相关。达到修复 MTD 阈值的 AAA 体积范围很广：女性患者为 102cm 至 142cm（n=5），男性患者为 105cm 至 229cm（n=20）。
发现基线 AAA 体积和 MTD 中度相关。AAA 体积平均每年增长约 10%。基线体积、迂曲度、MTD、当前吸烟、血管紧张素 II 受体阻滞剂的使用和糖尿病史是随时间预测体积增长的因素。
