Zhang Yidan, Shu Chang, Fang Kun, Chen Dong, Hou Zhihui, Luo Mingyao
State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Colege, Beijing, China.
State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Colege, Beijing, China; Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, China; Department of Vascular Surgery, Central-China Branch of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou 450046, China.
Eur J Radiol. 2024 Feb;171:111286. doi: 10.1016/j.ejrad.2024.111286. Epub 2024 Jan 3.
This study aimed to evaluate the association between the outflow morphology and abdominal aortic aneurysm (AAA) rupture risk, to find risk factors for future prediction models.
We retrospectively analyzed 46 patients with ruptured AAAs and 46 patients with stable AAAs using a 1:1 match for sex, age, and maximum aneurysm diameter. The chi-square test, paired t-test, and Wilcoxon signed-rank test were used to compare variables. Logistic regression was performed to evaluate variables potentially associated with AAA rupture. Receiver operating characteristic curve analysis and the area under the curve (AUC) were used to assess the regression models.
Ruptured AAAs had a shorter proximal aortic neck (median (interquartile range, IQR): 24.0 (9.4-34.2) mm vs. 33.3 (20.0-52.8) mm, p = 0.004), higher tortuosity (median(IQR): 1.35 (1.23-1.49) vs. 1.29 (1.23-1.39), p = 0.036), and smaller minimum luminal area of the right common iliac artery (CIA) (median (IQR): 86.7 (69.9-126.4) mm vs. 118.9 (86.3-164.1)mm, p = 0.001) and left CIA (median(IQR): 92.2 (67.3,125.1) mm vs. 110.7 (80.12, 161.1) mm, p = 0.010) than stable AAA did. Multiple regression analysis demonstrated significant associations of the minimum luminal area of the bilateral CIAs (odds ratio [OR] = 0.996, 95 % confidence interval [CI] 0.991-0.999, p = 0.037), neck length (OR = 0.969, 95 % CI 0.941-0.993, p = 0.017), and aneurysm tortuosity (OR = 1.031, 95 % CI 1.003-1.063, p = 0.038) with ruptured AAAs. The AUC of this regression model was 0.762 (95 % CI 0.664-0.860, p < 0.001).
The smaller minimum luminal area of the CIA is associated with an increased risk of rupture. This study highlights the potential of utilizing outflow parameters as novel and additional tools in risk assessment. It also provides a compelling rationale to further intensify research in this area.
本研究旨在评估流出道形态与腹主动脉瘤（AAA）破裂风险之间的关联，以寻找未来预测模型的风险因素。
我们采用1:1的性别、年龄和最大动脉瘤直径匹配方式，回顾性分析了46例破裂性AAA患者和46例稳定性AAA患者。使用卡方检验、配对t检验和Wilcoxon符号秩检验来比较变量。进行逻辑回归以评估可能与AAA破裂相关的变量。采用受试者工作特征曲线分析和曲线下面积（AUC）来评估回归模型。
与稳定性AAA相比，破裂性AAA的主动脉近端颈部较短（中位数（四分位间距，IQR）：24.0（9.4 - 34.2）mm对33.3（20.0 - 52.8）mm，p = 0.004），迂曲度更高（中位数（IQR）：1.35（1.23 - 1.49）对1.29（1.23 - 1.39），p = 0.036），右髂总动脉（CIA）最小管腔面积更小（中位数（IQR）：86.7（69.9 - 126.4）mm对118.9（86.3 - 164.1）mm，p = 0.001），左CIA最小管腔面积也更小（中位数（IQR）：92.2（67.3,125.1）mm对110.7（80.12, 161.1）mm，p = 0.010）。多元回归分析表明，双侧CIA的最小管腔面积（比值比[OR] = 0.996，95%置信区间[CI] 0.991 - 0.999，p = 0.037）、颈部长度（OR = 0.969，95% CI 0.941 - 0.993，p = 0.017）和动脉瘤迂曲度（OR = 1.031，95% CI 1.003 - 1.063，p = 0.038）与破裂性AAA显著相关。该回归模型的AUC为0.762（95% CI 0.664 - 0.860，p < 0.001）。
CIA最小管腔面积较小与破裂风险增加相关。本研究强调了利用流出道参数作为风险评估中新型和额外工具的潜力。它也为进一步加强该领域的研究提供了令人信服的理由。
