Jutidamrongphan Warissara, Kritpracha Boonprasit, Sörelius Karl, Chichareon Ply, Chongsuvivatwong Virasakdi, Sungsiri Jitpreedee, Rookkapan Sorracha, Premprabha Dhanakom, Juntarapatin Pong, Tantarattanapong Wittawat, Suwannanon Ruedeekorn
Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Eur J Vasc Endovasc Surg. 2023 Mar;65(3):425-432. doi: 10.1016/j.ejvs.2022.11.003. Epub 2022 Nov 3.
Endovascular aortic repair (EVAR) as surgical treatment for infective native aortic aneurysm (INAA) is associated with superior survival compared with open surgery, but with the risk of infection related complications (IRCs). This study aimed to assess the association between baseline clinical and computed tomography (CT) features and the risk of post-operative IRCs in patients treated with EVAR for INAA. It also sought to develop a model to predict long term IRCs in patients with abdominal INAA treated with EVAR.
All initial clinical details and CT examinations of INAAs between 2005 and 2020 at a major referral hospital were reviewed retrospectively. The images were scrutinised according to aneurysm features, as well as peri-aortic and surrounding organ involvement. Data on post-operative IRCs were found in the patient records. Cox regression analysis was used to derive predictors for IRCs and develop a model to predict five year IRCs after EVAR in abdominal INAA.
Of 3 780 patients with the diagnosis of aortic aneurysm or aortitis, 98 (3%) patients were treated with EVAR for abdominal INAAs and were thus included. The mean follow up time was 52 months (range 0 ‒ 163). The mean transaxial diameter was 6.5 ± 2.4 cm (range 2.1 ‒14.7). In the enrolled patients, 38 (39%) presented with rupture. The five year IRC rate in abdominal INAAs was 26%. Female sex, renal insufficiency, positive blood culture, aneurysm diameter, and psoas muscle involvement were predictive of five year IRC in abdominal INAA after EVAR. The model had a C-index of 0.76 (95% CI 0.66 - 0.87).
Pre-operative clinical and CT features have the potential to predict IRC after endovascular aortic repair in INAA patients. These findings stress the importance of rigorous clinical, laboratory, and radiological follow up in these patients.
与开放手术相比，血管腔内主动脉修复术（EVAR）作为感染性原发性主动脉瘤（INAA）的手术治疗方法，与更高的生存率相关，但存在感染相关并发症（IRC）的风险。本研究旨在评估接受EVAR治疗INAA患者的基线临床和计算机断层扫描（CT）特征与术后IRC风险之间的关联。该研究还试图建立一个模型，以预测接受EVAR治疗的腹部INAA患者的长期IRC。
回顾性分析了一家大型转诊医院2005年至2020年间所有INAAs的初始临床细节和CT检查。根据动脉瘤特征以及主动脉周围和周围器官受累情况仔细检查图像。在患者记录中发现术后IRC的数据。采用Cox回归分析得出IRC的预测因素，并建立一个模型来预测腹部INAA患者接受EVAR后五年的IRC。
在3780例诊断为主动脉瘤或主动脉炎的患者中，98例（3%）接受了EVAR治疗腹部INAA，因此被纳入研究。平均随访时间为52个月（范围0至163个月）。平均横轴直径为6.5±2.4cm（范围2.1至14.7cm）。在纳入的患者中，38例（39%）出现破裂。腹部INAA的五年IRC发生率为26%。女性、肾功能不全、血培养阳性、动脉瘤直径和腰大肌受累是EVAR后腹部INAA患者五年IRC的预测因素。该模型的C指数为0.76（95%CI 0.66 - 0.87）。
术前临床和CT特征有可能预测INAA患者血管腔内主动脉修复术后的IRC。这些发现强调了对这些患者进行严格的临床、实验室和放射学随访的重要性。
