Aoki Atsushi, Maruta Kazuto, Masuda Tomoaki, Omoto Tadashi
Department of Cardiovascular Surgery, Showa University, Tokyo, Japan.
Ann Vasc Dis. 2023;16(4):245-252. doi: 10.3400/avd.avd.oa.23-00065. Epub 2023 Sep 28.
The aneurysmal sac shrinkage has been reported as the strong predictor of favorable long-term outcome after endovascular aneurysm repair (EVAR). We evaluated the effects of perioperative and intraoperative factors on the aneurysm sac shrinkage. EVAR was performed for 296 patients during August 2009-December 2021. Nine patients with type Ia, Ib, or III; 69 patients with the sac diameter change less than 5 mm; and five patients with sac re-expansion after shrunk more than 5 mm were excluded. Thus, patients with sac shrinkage 5 mm or more (79 patients, shrinkage group) and with sac expansion 5 mm or more (18 patients) were included in this study. Antifibrinolytic therapy with tranexamic acid (TXA) 1500 mg/day for 6 months after EVAR was introduced in March 2013 and patent aortic side branches were coil embolized during EVAR since July 2015. Patients' background and patent aortic side branches at the end of EVAR were evaluated. Univariate analysis for comparison between patients with sac shrinkage and sac expansion revealed that males (82.3% vs. 55.6%, p = 0.021), without antiplatelet therapy (40.5% vs. 66.7%, p = 0.044) and TXA (79.8% vs. 38.9%, p <0.001), were significantly associated with sac shrinkage. By multivariate analysis, the odds ratio of sac shrinkage was 11.7 for males, 0.1 for the patients on antiplatelet therapy, and 6.5 for the patient who received TXA. The patients with patent inferior mesenteric artery (IMA) were less in the shrinkage group (20.3% vs. 77.8%, p <0.001) and with two or less patent lumbar arteries (LAs) were more in the shrinkage group (82.3% vs. 33.3%, p < 0.001). The odd ratio of sac shrinkage was 7.8 for occluded IMA and 3.9 for two or less patent LAs. The possibility of sac shrinkage would be high for the patient with occluded IMA and two or less patent LA at the end of EVAR, and that patient received TXA after EVAR. (This is a translation of 2022; : 291-297.).
动脉瘤囊缩小已被报道为血管内动脉瘤修复术（EVAR）后长期良好预后的有力预测指标。我们评估了围手术期和术中因素对动脉瘤囊缩小的影响。2009年8月至2021年12月期间对296例患者进行了EVAR。排除9例Ia型、Ib型或III型患者；69例囊直径变化小于5mm的患者；以及5例囊缩小超过5mm后再扩张的患者。因此，本研究纳入了囊缩小5mm或更多的患者（79例，缩小组）和囊扩张5mm或更多的患者（18例）。2013年3月开始在EVAR后使用氨甲环酸（TXA）1500mg/天进行6个月的抗纤维蛋白溶解治疗，自2015年7月起在EVAR期间对主动脉侧支进行弹簧圈栓塞。评估了患者的背景以及EVAR结束时的主动脉侧支情况。对囊缩小和囊扩张患者进行比较的单因素分析显示，男性（82.3%对55.6%，p = 0.021）、未接受抗血小板治疗（40.5%对66.7%，p = 0.044）和使用TXA（79.8%对38.9%，p <0.001）与囊缩小显著相关。多因素分析显示，男性囊缩小的比值比为11.7，接受抗血小板治疗的患者为0.1，接受TXA的患者为6.5。肠系膜下动脉（IMA）通畅的患者在缩小组中较少（20.3%对77.8%，p <0.001），而腰动脉（LA）通畅数量为两条或更少的患者在缩小组中较多（82.3%对33.3%，p <0.001）。IMA闭塞时囊缩小的比值比为7.8，LA通畅数量为两条或更少时为3.9。在EVAR结束时IMA闭塞且LA通畅数量为两条或更少的患者，囊缩小的可能性较高，且该患者在EVAR后接受了TXA治疗。（这是对2022; : 291 - 297.的翻译。）
