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破裂性腹主动脉瘤血管内修复术后两年的死亡率和危险因素差异——再评估分析。

Differences in mortality and risk factors, two years after endovascular repair of ruptured abdominal aortic aneurysms - Reassessment analysis.

机构信息

Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland.

Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.

出版信息

Ren Fail. 2024 Dec;46(2):2397051. doi: 10.1080/0886022X.2024.2397051. Epub 2024 Sep 9.

Abstract

OBJECTIVE

The prevalence of abdominal aortic aneurysms (AAA) increases with age. Elective intervention for AAA is critical to prevent rupture associated with very high mortality among older males.

METHODS

The aim of this study was to address the impact of post-contrast acute kidney-PC-AKI injury among patients treated with endovascular repair of ruptured AAA-EVAR on outcomes such as new onset chronic kidney disease-CKD and mortality among patients within a two-year trial.

RESULTS

The same study group (of  = 192 patients) underwent reassessment, two years after EVAR treatment. The overall mortality rate was 16.67%, and it was higher in the AKI group - 38.89%. CKD patients had a mortality rate of 23.88% ( = 16). Among patients with an aneurysm diameter >67 mm mortality rate reached 20% ( = 6), while in the previously reported diabetes mellitus group 37.93% ( = 11). New onset of CKD was diagnosed in 23% of cases. Preexisting CKD patients with PC- AKI contributed to a 33.33% mortality rate ( = 8).

CONCLUSION

This study concludes that PC-AKI impacts outcomes and survival in endovascularly treated AAAs. Type 2 diabetes and preexisting chronic kidney disease are associated with higher mortality within a 2-year follow-up, however gender factor was not significant. A larger aneurysm diameter is related with a higher prevalence of PC-AKI. These factors should be taken into account during screening, qualifying patients for the treatment and treating patients with AAA. It may help to identify high-risk individuals and tailor preventive measurements and treatment options accordingly, improving treatment results and reducing mortality.

摘要

目的

腹主动脉瘤(AAA)的患病率随年龄增长而增加。对 AAA 进行择期干预对于预防破裂至关重要,破裂可导致老年男性死亡率非常高。

方法

本研究旨在探讨接受破裂性腹主动脉瘤腔内修复术(EVAR)治疗的患者发生造影剂后急性肾损伤(PC-AKI)对 2 年试验内新发慢性肾脏病(CKD)和死亡率等结局的影响。

结果

同一研究组(=192 例患者)在 EVAR 治疗后 2 年接受了重新评估。总的死亡率为 16.67%,在 AKI 组更高-38.89%。CKD 患者的死亡率为 23.88%(=16)。动脉瘤直径>67mm 的患者死亡率达到 20%(=6),而在之前报道的糖尿病组中死亡率为 37.93%(=11)。新诊断出 CKD 的患者占 23%。PC-AKI 导致原有 CKD 患者的死亡率达到 33.33%(=8)。

结论

本研究得出结论,PC-AKI 影响腔内治疗的 AAA 的结局和生存率。2 年随访期间,2 型糖尿病和原有慢性肾脏病与更高的死亡率相关,但性别因素无显著意义。更大的动脉瘤直径与更高的 PC-AKI 发生率相关。这些因素应在筛选、确定治疗患者和治疗 AAA 患者时加以考虑。它可以帮助识别高风险个体,并相应地制定预防性措施和治疗方案,从而改善治疗结果并降低死亡率。

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