van Rijswijk Rianne E, Groot Jebbink Erik, Holewijn Suzanne, Stoop Nicky, van Sterkenburg Steven M, Reijnen Michel M P J
Department of Vascular Surgery, Rijnstate, 6815 AD Arnhem, The Netherlands.
Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, 7522 NH Enschede, The Netherlands.
J Clin Med. 2022 Mar 3;11(5):1394. doi: 10.3390/jcm11051394.
Recent studies demonstrate that patients with a shrinking abdominal aortic aneurysm (AAA), one-year after endovascular repair (EVAR), have better long-term outcomes than patients with a stable AAA. It is not known what factors determine whether an AAA will shrink or not. In this study, a range of parameters was investigated to identify their use in differentiating patients that will develop a shrinking AAA from those with a stable AAA one-year after EVAR. Hundred-seventy-four patients (67 shrinking AAA, 107 stable AAA) who underwent elective, infrarenal EVAR were enrolled between 2011-2018. Long-term survival was significantly better in patients with a shrinking AAA, compared to those with a stable AAA ( = 0.038). Larger preoperative maximum AAA diameter was associated with an increased likelihood of developing AAA shrinkage one-year after EVAR-whereas older age and larger preoperative infrarenal β angle were associated with a reduced likelihood of AAA shrinkage. However, this multivariate logistic regression model was only able to correctly identify 66.7% of patients with AAA shrinkage from the total cohort. This is not sufficient for implementation in clinical care, and therefore future research is recommended to dive deeper into AAA anatomy, and explore potential predictors using artificial intelligence and radiomics.
近期研究表明，腹主动脉瘤（AAA）患者在接受血管腔内修复术（EVAR）一年后，瘤体缩小的患者比瘤体稳定的患者具有更好的长期预后。目前尚不清楚哪些因素决定AAA是否会缩小。在本研究中，对一系列参数进行了调查，以确定它们在区分EVAR术后一年瘤体将缩小的AAA患者和瘤体稳定的AAA患者中的作用。2011年至2018年期间，纳入了174例行择期肾下EVAR的患者（67例瘤体缩小的AAA患者，107例瘤体稳定的AAA患者）。与瘤体稳定的AAA患者相比，瘤体缩小的AAA患者的长期生存率显著更高（ = 0.038）。术前最大AAA直径越大，EVAR术后一年AAA缩小的可能性越高；而年龄越大和术前肾下β角越大，AAA缩小的可能性越低。然而，该多因素逻辑回归模型仅能从整个队列中正确识别出66.7%的AAA缩小患者。这对于临床应用来说是不够的，因此建议未来的研究更深入地研究AAA的解剖结构，并利用人工智能和放射组学探索潜在的预测因素。
