Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (Y.S., H.M.).
Department of Cardiovascular Surgery, Keio University, Tokyo, Japan (H.S.).
Circulation. 2022 Apr 5;145(14):1056-1066. doi: 10.1161/CIRCULATIONAHA.121.056581. Epub 2022 Feb 25.
We reviewed the results of endovascular aneurysm repair in patients from the Japanese Committee for Stentgraft Management registry to determine the significance of persistent type II endoleak (p-T2EL) and the risk of late adverse events, including aneurysm sac enlargement.
The prospectively captured medical records of 17 099 patients <75 years of age who underwent endovascular aneurysm repair for abdominal aortic aneurysm from 2006 to 2015 were reviewed. Patients were divided into 2 groups (with or without p-T2EL) and compared to examine the correlation between p-T2EL and the occurrence of aneurysm sac enlargement after endovascular aneurysm repair.
Of the patients, 4957 (29.0%) had p-T2EL and 12 142 (71.0%) had no p-T2EL (non-T2EL). Mean age was significantly higher (<0.001), and there were fewer men (<0.001) in the p-T2EL group. Among comorbidities, hypertension (=0.019) and chronic kidney disease (=0.040) were more prevalent and respiratory disorders were less prevalent (<0.001) in the p-T2EL group. From each group, 4957 patients were matched according to propensity score to adjust for differences in patient characteristics. The cumulative incidence rates of abdominal aortic aneurysm-related mortality (p-T2EL: 52 of 4957 [1.0%] versus non-T2EL: 21 of 12 142 [0.2%]), rupture (p-T2EL: 38 of 4957 [0.8%] versus non-T2EL: 13 of 12 142 [0.1%]), sac enlargement (≥5 mm; p-T2EL: 1359 of 4957 [27.4%] versus non-T2EL: 332 of 12 142 [2.7%]), and reintervention (p-T2EL: 739 of 4957 [14.9%] versus non-T2EL: 91 of 12 142 [0.7%]) were significantly higher in the p-T2EL than the nonpT2EL group (<0.001). Propensity score matching yielded higher estimated incremental risk, including abdominal aortic aneurysm-related mortality, rupture, sac enlargement (≥5 mm), and reintervention for p-T2EL (<0.001). Cox regression analysis revealed older age (=0.010), proximal neck diameter (=0.003), and chronic kidney disease (<0.001) as independent positive predictors and male sex as an independent negative predictor (=0.015) of sac enlargement.
The Japanese Committee for Stentgraft Management registry data show a correlation between p-T2EL and late adverse events, including aneurysm sac enlargement, reintervention, rupture, and abdominal aortic aneurysm-related mortality after endovascular aneurysm repair. Besides p-T2EL, older age, female sex, chronic kidney disease, and dilated proximal neck were associated with sac enlargement.
我们回顾了日本支架管理委员会注册中心接受血管内动脉瘤修复治疗的患者的结果，以确定持续性 II 型内漏（p-T2EL）的意义以及包括动脉瘤囊扩大在内的晚期不良事件的风险。
回顾了 2006 年至 2015 年间接受腹主动脉瘤血管内动脉瘤修复治疗的<75 岁患者的前瞻性捕获病历。患者分为 2 组（有或无 p-T2EL），以检查 p-T2EL 与血管内动脉瘤修复后动脉瘤囊扩大之间的相关性。
在患者中，有 4957 名（29.0%）有 p-T2EL，12142 名（71.0%）无 p-T2EL（非 T2EL）。年龄明显较高（<0.001），p-T2EL 组男性较少（<0.001）。在合并症中，高血压（=0.019）和慢性肾脏病（=0.040）更为常见，呼吸障碍较少（<0.001）。从每组中，根据倾向评分匹配 4957 名患者，以调整患者特征的差异。腹主动脉瘤相关死亡率（p-T2EL：4957 名中的 52 名[1.0%]与非-T2EL：12142 名中的 21 名[0.2%]）、破裂（p-T2EL：4957 名中的 38 名[0.8%]与非-T2EL：12142 名中的 13 名[0.1%]）、囊扩大（≥5 毫米；p-T2EL：4957 名中的 1359 名[27.4%]与非-T2EL：12142 名中的 332 名[2.7%]）和再干预（p-T2EL：4957 名中的 739 名[14.9%]与非-T2EL：12142 名中的 91 名[0.7%]）在 p-T2EL 组中明显高于非 pT2EL 组（<0.001）。倾向评分匹配产生了更高的估计增量风险，包括腹主动脉瘤相关死亡率、破裂、囊扩大（≥5 毫米）和再干预（<0.001）。Cox 回归分析显示，年龄较大（=0.010）、近端颈部直径（=0.003）和慢性肾脏病（<0.001）是囊扩大的独立阳性预测因子，男性为独立阴性预测因子（=0.015）。
日本支架管理委员会注册中心的数据表明，p-T2EL 与血管内动脉瘤修复后的晚期不良事件，包括动脉瘤囊扩大、再干预、破裂和腹主动脉瘤相关死亡率之间存在相关性。除了 p-T2EL 外，年龄较大、女性、慢性肾脏病和扩张的近端颈部与囊扩大有关。
