Petroula Nana, Konstantinos Spanos, Nikolaos Tsilimparis, Stéphan Haulon, Jonathan Sobocinski, Enrico Gallitto, Nuno Dias, Wolf Eilenberg, Anders Wanhainen, Kevin Mani, Dittmar Böckler, Luca Bertoglio, Carla van Rijswijk, Bijan Modarai, Arne Seternes, Florian K Enzmann, Athanasios Giannoukas, Mauro Gargiulo, Tilo Kölbel
{"title":"抗血小板疗法在使用穿孔或分支血管内修复术治疗复杂主动脉瘤患者中的作用","authors":"Petroula Nana, Konstantinos Spanos, Nikolaos Tsilimparis, Stéphan Haulon, Jonathan Sobocinski, Enrico Gallitto, Nuno Dias, Wolf Eilenberg, Anders Wanhainen, Kevin Mani, Dittmar Böckler, Luca Bertoglio, Carla van Rijswijk, Bijan Modarai, Arne Seternes, Florian K Enzmann, Athanasios Giannoukas, Mauro Gargiulo, Tilo Kölbel","doi":"10.1016/j.ejvs.2024.09.030","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":5.7000,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Role of Antiplatelet Therapy in Patients Managed for Complex Aortic Aneurysms using Fenestrated or Branched Endovascular Repair.\",\"authors\":\"Petroula Nana, Konstantinos Spanos, Nikolaos Tsilimparis, Stéphan Haulon, Jonathan Sobocinski, Enrico Gallitto, Nuno Dias, Wolf Eilenberg, Anders Wanhainen, Kevin Mani, Dittmar Böckler, Luca Bertoglio, Carla van Rijswijk, Bijan Modarai, Arne Seternes, Florian K Enzmann, Athanasios Giannoukas, Mauro Gargiulo, Tilo Kölbel\",\"doi\":\"10.1016/j.ejvs.2024.09.030\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Despite the increasing number of fenestrated and branched endovascular aortic repair (F/B-EVAR) procedures, evidence on post-operative antiplatelet therapy is very limited. 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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). 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引用次数: 0
摘要
目的：尽管带瓣/带支主动脉瓣修复术（f/bEVAR）的数量不断增加，但缺乏术后抗血小板治疗的证据。本研究旨在探讨单抗血小板疗法（SAPT）与双抗血小板疗法（DAPT）在 f/bEVAR 术后 30 天和随访结果中的作用：进行了一项多中心回顾性分析，包括2018年1月1日至2022年12月31日期间接受治疗的f/bEVAR患者。比较结果根据术后抗血小板治疗进行评估。队列分为 SAPT 组（乙酰水杨酸 [ASA] 或氯吡格雷）和 DAPT 组（ASA 和氯吡格雷）。SAPT 或 DAPT 的持续时间为一至六个月。主要结果为30天死亡、心血管缺血性和大出血事件。次要结果是随访期间的存活率和靶血管（TV）通畅率：共纳入 1 430 名患者：结果：共纳入了 1 430 名患者：955 名接受 SAPT 治疗，475 名接受 DAPT 治疗。30天死亡率相似（SAPT为2.1%，DAPT为1.5%；P = .42）。DAPT组的心血管缺血事件较少（SAPT 11.9% vs. DAPT 8.2%; p = .040），DAPT对急性肠系膜缺血（p = .009）和下肢缺血（p = .020）具有独立的保护作用。在 30 天的大出血事件中没有发现差异（SAPT 7.5% 对 DAPT 6.3%；p = .40）。平均随访时间为 21.8±2.9 个月。Cox 回归结果显示，各组之间的生存率相似（对数秩 p = .71），没有共同因素。DAPT患者在36个月时的TV通畅率更高（SAPT 93.4%, 标准误差 [SE] 0.7% vs. DAPT 96.6%, 标准误差 0.7%; log rank p = .007）。Cox 回归显示，bEVAR 是预测电视通畅率降低的一个因素（危险比 2.03，95% 置信区间 1.36 - 3.03；p < .001）。DAPT与bEVAR患者较高的通畅率有关（SAPT 87.2%, SE 2.1% vs. DAPT 94.9%, SE 1.9%; p < .001）：F/BEVAR术后DAPT与较低的心血管缺血性事件风险和较高的TV通畅率相关，尤其是在BEVAR病例中。30天后观察到的大出血事件没有差异。
Role of Antiplatelet Therapy in Patients Managed for Complex Aortic Aneurysms using Fenestrated or Branched Endovascular Repair.
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.
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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