Lipski D A, Ernst C B
Department of Surgery, Henry Ford Hospital, Detroit, Mich, USA.
J Vasc Surg. 1998 May;27(5):805-11; discussion 811-2. doi: 10.1016/s0741-5214(98)70259-9.
We determined the natural history of the residual native infrarenal aortic segment after conventional abdominal aortic aneurysm (AAA) repair.
For the retrospective arteriographic case series, 800 hundred translumbar aortograms (TLAs) were obtained for 272 patients, before and after conventional AAA repair. The main outcome measures were changes in the aortographic diameter and the length of the infrarenal aortic segment, corrected and uncorrected for magnification by normalization to the first lumbar vertebral body height.
The mean follow-up time from the preoperative TLA to the most recent postoperative TLA was 42 months (range, 1 to 257 months). Vertebral body height did not change (p = 0.35). The length of the native infrarenal aorta cephalad to the proximal anastomosis increased a mean of 3 mm, from 23 to 26 mm (p = 0.001). However, in 115 patients (43%), this aortic segment elongated more than 5 mm, and in 63 patients (24%), it elongated more than 10 mm. The native residual infrarenal aorta above the proximal anastomosis dilated a mean of 1 mm, from 23 to 24 mm (p = 0.001), but in 21 patients (8%), it dilated more than 5 mm. There was a weak positive correlation between the increase in residual native aortic diameter and duration of follow-up. There was a negative correlation between this increase and the initial size. The diameters of the proximal anastomosis and proximal graft did not change. Marked variability in the changes in aortic dimensions was observed.
A mean period of 42 months after conventional AAA repair, the native infrarenal aortic segment elongates and dilates. Although such enlargement is statistically significant, the average increase appears to be small. However, residual aortic cuff diameter increased more than 5 mm and neck length more than 10 mm in a significant number of patients, with potentially serious implications for endovascular treatment of AAA.
我们确定了传统腹主动脉瘤（AAA）修复术后残余的肾下腹主动脉节段的自然病程。
对于这项回顾性血管造影病例系列研究，在传统AAA修复术前和术后，为272例患者获取了800张经腰主动脉造影（TLA）图像。主要观察指标为经腰主动脉造影显示的直径变化以及肾下腹主动脉节段的长度变化，通过与第一腰椎椎体高度进行归一化处理来校正和未校正放大倍数。
从术前TLA到最近一次术后TLA的平均随访时间为42个月（范围为1至257个月）。椎体高度未发生变化（p = 0.35）。肾下腹主动脉近端吻合口上方的节段长度平均增加了3 mm，从23 mm增至26 mm（p = 0.001）。然而，在115例患者（43%）中，该主动脉节段伸长超过5 mm，在63例患者（24%）中，伸长超过10 mm。近端吻合口上方的残余肾下腹主动脉平均扩张了1 mm，从23 mm增至24 mm（p = 0.001），但在21例患者（8%）中，扩张超过5 mm。残余肾主动脉直径的增加与随访时间呈弱正相关。这种增加与初始大小呈负相关。近端吻合口和近端移植物的直径未发生变化。观察到主动脉尺寸变化存在显著差异。
传统AAA修复术后平均42个月时，残余的肾下腹主动脉节段会伸长和扩张。尽管这种增大在统计学上具有显著性，但平均增加幅度似乎较小。然而，相当数量的患者残余主动脉袖带直径增加超过5 mm，颈部长度增加超过10 mm，这对AAA的血管内治疗可能具有潜在的严重影响。
