Long-term impact of dyslipidemia on sac dynamics after endovascular aortic repair for abdominal aortic aneurysms in the GREAT registry: An insight in dyslipidemia using propensity matched controls.

IF 0.9 4区 医学 Q4 PERIPHERAL VASCULAR DISEASE
Vascular Pub Date : 2025-09-18 DOI:10.1177/17085381251377316
Bibombe P Mwipatayi, James E Dodd, Shannon D Thomas, Elizabeth L Chou, Ross Milner, Ali Azizzadeh, Santi Trimarchi, Jan Mm Heyligers, Dittmar Böckler, Markus P Schlaich
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引用次数: 0

Abstract

ObjectivesTo investigate the differences in aneurysmal sac regression after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs) in patients with and without dyslipidemia.MethodsThis was a retrospective analysis of 3453 patients from an international prospective registry (Europe, United States of America, Brazil, Australia, and New Zealand) of patients treated with the GORE® EXCLUDER® endograft. All scheduled EVARs for infrarenal AAAs between 2014 and 2016 with complete 6-year follow-up imaging data were included. Logistic regression analysis was performed to assess changes in aneurysm diameter based on dyslipidemia after adjusting for sex, age, body mass index, tobacco use, hypertension, coronary artery disease, aneurysm diameter, aneurysm neck length, and aneurysm neck angle. The secondary outcomes included all-cause mortality, stroke/transient ischemic attack (TIA), paraplegia/paraparesis/spinal cord ischemia, reintervention, endoleaks, and aortic rupture. A control group of patients without dyslipidemia with similar age and comorbidities was selected using propensity scores and matched using a 1:1 scheme.ResultsOf the 3453 patients, 85.3% in the non-dyslipidemia group and 85.5% in the dyslipidemia group were men. The mean age was 73.5 ± 8.8 years for the non-dyslipidemia group and 73.4 ± 8.2 years for the dyslipidemia group (p < .001). The mean body mass index was 26.7 ± 4.9 kg/m2 for the non-dyslipidemia group, whereas it was 28.0 ± 5.2 kg/m2 for the dyslipidemia group (p < .001). Overall, 2269 patients (64.0%) were identified as having dyslipidemia. After propensity score matching (PSM), the dyslipidemia group had higher rates of hypertension (p < .001), TIA (p = .006), carotid disease (p = .002), coronary artery bypass grafting (p = .005), congestive cardiac failure (p = .018), and peripheral artery disease (p < .001). The indications for device placement were similar between the groups. After PSM, the non-dyslipidemia group was more likely to be treated off-label (p = .030) and to have an aneurysm neck length of <15 mm (p = .035). There was no significant difference in the sac size changes within 1 year (p = .7) or 6 years (p = .14) between the groups. After PSM, all-cause mortality was 6.7% in individuals with dyslipidemia and 10.6% in those without (p = .018). However, there were no significant differences in aortic-related mortality between the overall (p = .571) and the matched (p = .662) populations. The rates of reintervention, stroke/transient ischemic attack, and spinal cord ischemia were not significantly different. Among patients with dyslipidemia, larger aneurysm size at 1 year (p = .037) and increased age at 6 years (p < .001) were associated with sac expansion.ConclusionIn this comprehensive real-world study of patients who underwent EVAR with the GORE® EXCLUDER endoprosthesis found that dyslipidemia did not increase endoleak rates or worsen imaging outcomes over 6 years. Overall, these findings suggest that dyslipidemia does not negatively impact EVAR outcomes and may indicate improved long-term care.

在GREAT登记中,腹主动脉瘤血管内主动脉修复后血脂异常对囊动力学的长期影响:使用倾向匹配对照的血脂异常洞察
目的探讨伴有和不伴有血脂异常的腹主动脉瘤(AAAs)血管内修复(EVAR)后动脉瘤囊消退的差异。方法回顾性分析来自国际前瞻性登记中心(欧洲、美国、巴西、澳大利亚和新西兰)的3453例接受GORE®exender®内移植物治疗的患者。纳入2014年至2016年期间所有计划的颅内AAAs EVARs,并提供完整的6年随访影像数据。在调整性别、年龄、体重指数、吸烟、高血压、冠状动脉疾病、动脉瘤直径、动脉瘤颈长和动脉瘤颈角等因素后,采用Logistic回归分析评估血脂异常对动脉瘤直径的影响。次要结局包括全因死亡率、中风/短暂性脑缺血发作(TIA)、截瘫/截瘫/脊髓缺血、再干预、内漏和主动脉破裂。采用倾向评分法选择无血脂异常、年龄相近、合并症的对照组,并采用1:1匹配方案。结果3453例患者中,非血脂异常组85.3%为男性,血脂异常组85.5%为男性。非血脂异常组的平均年龄为73.5±8.8岁,血脂异常组的平均年龄为73.4±8.2岁(p < 0.001)。非血脂异常组的平均体重指数为26.7±4.9 kg/m2,血脂异常组的平均体重指数为28.0±5.2 kg/m2 (p < 0.001)。总体而言,2269例患者(64.0%)被确定为患有血脂异常。经倾向评分匹配(PSM)后,血脂异常组高血压(p < 0.001)、TIA (p = 0.006)、颈动脉疾病(p = 0.002)、冠状动脉旁路移植术(p = 0.005)、充血性心力衰竭(p = 0.018)和外周动脉疾病(p < 0.001)的发生率较高。两组间放置器械的适应症相似。PSM后,非血脂异常组更有可能接受标签外治疗(p = 0.030),动脉瘤颈长度p = 0.035)。两组间1年(p = 0.7)和6年(p = 0.14)囊大小变化无显著差异。PSM后,血脂异常患者的全因死亡率为6.7%,无血脂异常患者的全因死亡率为10.6% (p = 0.018)。然而,在总体人群(p = .571)和匹配人群(p = .662)之间,主动脉相关死亡率没有显著差异。再干预率、卒中/短暂性脑缺血发作率和脊髓缺血率无显著差异。在血脂异常的患者中,1岁时较大的动脉瘤尺寸(p = 0.037)和6岁时增大的年龄(p < 0.001)与囊扩张相关。结论:在这项对使用GORE®exuder假体进行EVAR的患者进行的全面现实研究中,发现血脂异常在6年内没有增加内漏率或恶化成像结果。总的来说,这些发现表明,血脂异常不会对EVAR结果产生负面影响,并可能表明改善了长期护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Vascular
Vascular 医学-外周血管病
CiteScore
2.30
自引率
9.10%
发文量
196
审稿时长
6-12 weeks
期刊介绍: Vascular provides readers with new and unusual up-to-date articles and case reports focusing on vascular and endovascular topics. It is a highly international forum for the discussion and debate of all aspects of this distinct surgical specialty. It also features opinion pieces, literature reviews and controversial issues presented from various points of view.
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