Yale School of Medicine, New Haven, CT.
Yale School of Medicine, New Haven, CT.
J Vasc Surg. 2023 Jun;77(6):1649-1657. doi: 10.1016/j.jvs.2023.02.003. Epub 2023 Feb 14.
Ruptured abdominal aortic aneurysms (rAAA) are associated typically with a large sac diameter; however, some patients experience rupture before reaching operative thresholds for elective repair. We aim to investigate the characteristics and outcomes of patients who experience small rAAA.
The Vascular Quality Initiative database for open AAA repair and endovascular aneurysm repair from 2003 to 2020 were reviewed for all rAAA cases. Based on the 2018 Society for Vascular Surgery guidelines on operative size thresholds for elective repair, patients with infrarenal aneurysms of less than 5.0 cm in women or less than 5.5 cm in men were categorized as a small rAAA. Patients who met operative thresholds or had a concomitant iliac diameter 3.5 cm or greater were categorized as a large rAAA. Patient characteristics and perioperative as well as long-term outcomes were compared via univariate regression. Inverse probability of treatment weighting using propensity scores was used to examine the relationship between rAAA size and adverse outcomes.
There were 3962 cases that met inclusion criteria, with 12.2% small rAAA. The mean aneurysm diameter was 42.3 mm and 78.5 mm in the small and large rAAA groups, respectively. Patients in the small rAAA group were significantly more likely to be younger, African American, have a lower body mass index, and had significantly higher rates of hypertension. Small rAAA were more likely to be repaired via endovascular aneurysm repair (P = .001). Hypotension was significantly less likely in patients with small rAAA (P<.001). Rates of perioperative myocardial infarction (P < .001), total morbidity (P < .004) and mortality (P < .001) were significantly higher for large rAAA cases. After propensity matching, there was no significant difference in mortality between the two groups, but smaller rAAA was associated with lower rates of myocardial infarction (odds ratio, 0.50; 95% confidence interval, 0.31-0.82). On long-term follow-up, no difference in mortality was noted between the two groups.
Patients presenting with small rAAA represent 12.2% of all rAAA and are more likely to be African American. Small rAAA is associated with similar risk of perioperative and long-term mortality compared with rupture at larger size after risk adjustment.
破裂的腹主动脉瘤（rAAA）通常与较大的瘤囊直径相关；然而，一些患者在达到择期修复的手术阈值之前就发生了破裂。我们旨在研究经历小 rAAA 的患者的特征和结局。
对 2003 年至 2020 年血管质量倡议数据库中所有 rAAA 病例进行了回顾，包括开放腹主动脉瘤修复和血管内动脉瘤修复。根据 2018 年血管外科学会关于择期修复手术大小阈值的指南，女性肾下动脉瘤小于 5.0cm 或男性肾下动脉瘤小于 5.5cm 的患者被归类为小 rAAA。符合手术阈值或伴有髂直径大于 3.5cm 的患者被归类为大 rAAA。通过单变量回归比较患者特征以及围手术期和长期结局。使用倾向评分进行逆概率治疗加权以检查 rAAA 大小与不良结局之间的关系。
共有 3962 例符合纳入标准，其中小 rAAA 占 12.2%。小 rAAA 和大 rAAA 组的平均动脉瘤直径分别为 42.3mm 和 78.5mm。小 rAAA 组的患者明显更年轻、非裔美国人、体重指数较低，高血压发生率明显较高。小 rAAA 更有可能通过血管内动脉瘤修复（P=0.001）进行修复。小 rAAA 患者发生低血压的可能性明显较低（P<.001）。大 rAAA 患者围手术期心肌梗死（P<.001）、总发病率（P<.004）和死亡率（P<.001）的发生率明显较高。经过倾向评分匹配后，两组之间的死亡率没有显著差异，但较小的 rAAA 与较低的心肌梗死发生率相关（优势比，0.50；95%置信区间，0.31-0.82）。长期随访中，两组之间的死亡率没有差异。
小 rAAA 患者占所有 rAAA 的 12.2%，且更有可能是非裔美国人。小 rAAA 与较大尺寸破裂后进行风险调整的围手术期和长期死亡率相似。
