编辑推荐——抗血小板治疗在采用开窗或分支型血管腔内修复术治疗复杂主动脉瘤患者中的作用
Editor's Choice - Role of Antiplatelet Therapy in Patients Managed for Complex Aortic Aneurysms using Fenestrated or Branched Endovascular Repair.
作者信息
Nana Petroula, Spanos Konstantinos, Tsilimparis Nikolaos, Haulon Stéphan, Sobocinski Jonathan, Gallitto Enrico, Dias Nuno, Eilenberg Wolf, Wanhainen Anders, Mani Kevin, Böckler Dittmar, Bertoglio Luca, van Rijswijk Carla, Modarai Bijan, Seternes Arne, Enzmann Florian K, Giannoukas Athanasios, Gargiulo Mauro, Kölbel Tilo
机构信息
German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany.
German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany.
出版信息
Eur J Vasc Endovasc Surg. 2025 Feb;69(2):272-281. doi: 10.1016/j.ejvs.2024.09.030. Epub 2024 Sep 24.
OBJECTIVE
Despite the increasing number of fenestrated and branched endovascular aortic repair (F/B-EVAR) procedures, evidence on post-operative antiplatelet therapy is very limited. This study aimed to investigate the role of single antiplatelet therapy (SAPT) vs. double antiplatelet therapy (DAPT) after F/B-EVAR in 30 day and follow up outcomes.
METHODS
A multicentre retrospective analysis was conducted, including F/B-EVAR patients managed from 1 January 2018 to 31 December 2022. Comparative outcomes were assessed according to post-operative antiplatelet therapy. The cohort was divided into the SAPT group (acetylsalicylic acid [ASA] or clopidogrel) and DAPT group (ASA and clopidogrel). The duration of SAPT or DAPT was one to six months. Primary outcomes were 30 day death, and cardiovascular ischaemic and major haemorrhagic events. Secondary outcomes were survival and target vessel (TV) patency during follow up.
RESULTS
A total of 1 430 patients were included: 955 under SAPT and 475 under DAPT. The 30 day mortality rate was similar (SAPT 2.1% vs. DAPT 1.5%; p = .42). Cardiovascular ischaemic events were lower in the DAPT group (SAPT 11.9% vs. DAPT 8.2%; p = .040), with DAPT being an independent protector for acute mesenteric (p = .009) and lower limb ischaemia (p = .020). No difference was found in 30 day major haemorrhagic events (SAPT 7.5% vs. DAPT 6.3%; p = .40). The mean follow up was 21.8 ± 2.9 months. Cox regression showed no survival confounders, with similar rates between groups (log rank p = .71). DAPT patients enjoyed higher TV patency (SAPT 93.4%, standard error [SE] 0.7% vs. DAPT 97.0%, SE 0.6%; log rank p = .007) at thirty six months. Cox regression revealed B-EVAR as a predictor of worse TV patency (hazard ratio 2.03, 95% confidence interval 1.36 - 3.03; p < .001). DAPT was related to higher patency within B-EVAR patients (SAPT 87.2%, SE 2.1% vs. DAPT 94.9%, SE 1.9%; p < .001).
CONCLUSION
DAPT after F/B-EVAR was associated with lower risk of cardiovascular ischaemic events and higher TV patency, especially in B-EVAR cases. No difference in major haemorrhagic events was observed at 30 days.
目的
尽管开窗和分支型血管腔内主动脉修复术（F/B-EVAR）的手术数量不断增加，但关于术后抗血小板治疗的证据非常有限。本研究旨在探讨F/B-EVAR术后单药抗血小板治疗（SAPT）与双联抗血小板治疗（DAPT）在30天及随访结果中的作用。
方法
进行了一项多中心回顾性分析，纳入2018年1月1日至2022年12月31日接受F/B-EVAR治疗的患者。根据术后抗血小板治疗评估比较结果。队列分为SAPT组（阿司匹林[ASA]或氯吡格雷）和DAPT组（ASA和氯吡格雷）。SAPT或DAPT的持续时间为1至6个月。主要结局为30天死亡、心血管缺血和重大出血事件。次要结局为随访期间的生存率和靶血管（TV）通畅情况。
结果
共纳入1430例患者：955例接受SAPT，475例接受DAPT。30天死亡率相似（SAPT组为2.1%，DAPT组为1.5%；p = 0.42）。DAPT组的心血管缺血事件较低（SAPT组为11.9%，DAPT组为8.2%；p = 0.040），DAPT是急性肠系膜缺血（p = 0.009）和下肢缺血（p = 0.020）的独立保护因素。30天重大出血事件无差异（SAPT组为7.5%，DAPT组为6.3%；p = 0.40）。平均随访时间为21.8±2.9个月。Cox回归显示无生存混杂因素，两组发生率相似（对数秩检验p = 0.71）。DAPT患者在36个月时TV通畅率更高（SAPT组为93.4%，标准误[SE]为0.7%，DAPT组为97.0%，SE为0.6%；对数秩检验p = 0.007）。Cox回归显示B-EVAR是TV通畅情况较差的预测因素（风险比2.03，95%置信区间1.36 - 3.03；p < 0.001）。DAPT与B-EVAR患者中更高的通畅率相关（SAPT组为87.2%，SE为2.1%，DAPT组为94.9%，SE为1.9%；p < 0.001）。
结论
F/B-EVAR术后DAPT与心血管缺血事件风险较低和TV通畅率较高相关，尤其是在B-EVAR病例中。30天时重大出血事件无差异。
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