在腘动脉动脉瘤的初始表现中,腔内血栓体积与小腿血管流量相关。

IF 2.4 4区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Hans-Christian Arne Stroth, Floris Berg, Hannah Emilia Freytag, Christian Reeps, Steffen Wolk, Ralf-Thorsten Hoffmann, Heiner Nebelung, Jens-Peter Kühn, Albert Busch, Marvin Kapalla
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引用次数: 0

摘要

背景:由于腘动脉动脉瘤(PAA)引起的缺血而进行紧急手术的患者在所有终点(手术时间、主要肢体不良事件(MALE)、无截肢生存期)都比选择性治疗后的结果更差,主要是由于脚部血管径流有限。本研究探讨了PAA直径、体积和管腔血栓负荷与术前脚血流的关系。患者和方法:回顾性单中心评估手术治疗的PAA患者和半自动化定量CT分析PAA形态学(直径、体积和腔内血栓体积)。主要终点是这些特征与未闭脚血管数量的相关性。结果:共89例PAAs(61例,中位年龄75岁,IQR 12;94.4%为男性,其中47.2%为急性肢体缺血(ALI)。术中直径为33.8±12.1mm,体积为68.5±13.6mm3。术前CTA时,两条下肢血管中位数通畅(选择性血管3 [1,2,3]vs紧急血管1 [1,2],p=0.1)。77例PAAs行择期手术,5例(5.6%)PAAs行血管内治疗。未立即或早期闭塞的手术并发症发生率为23.6%。随访42.5个月[39 ~ 45]。总死亡率为11.2%,原发性通畅率为73.9%。结论:在PAAs中,腔内血栓体积的增加与脚静脉径流量的减少最明显相关,因此应被认为具有重要的预后意义,特别是在与直径相比生长速度增加的情况下。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intraluminal thrombus volume correlates with the crural vessel runoff in popliteal artery aneurysms upon initial presentation.

Background: Patients having emergency surgery due to ischemia caused by a popliteal artery aneurysm (PAA) have worse outcomes in all endpoints (operation time, major adverse limb events (MALE), amputation-free survival) than after elective treatment, mostly due to a limited crural vessel runoff. This study investigates the relationship between PAA diameter, volume, and luminal thrombus load in relation to the preoperative crural runoff. Patients and methods: Retrospective single-centre evaluation of surgically treated patients with PAA and semi-automated quantitative CT analysis of PAA morphologies (diameter, volume and intraluminal thrombus volume). Primary endpoints were the correlations these characteristics with the number of patent crural vessels. Results: A total of 89 PAAs (61 patients, median age 75, IQR 12; 94.4% male) were identified, of which 47.2% were symptomatic with 18 acute limb ischemia (ALI). The diameter at surgery was 33.8 ± 12.1mm and the volume 68.5 ± 13.6mm3. A median of two lower leg vessels were patent (elective 3 [1, 2, 3] vs. emergency 1 [1, 2], p=0.1) upon preoperative CTA. 77 PAAs underwent elective surgery, five PAAs (5.6%) received endovascular treatment. The surgical complication rate was 23.6% without immediate or early occlusion. The follow-up was 42.5 [39-45] months. The overall mortality rate was 11.2% and the primary patency rate 73.9%. While the total aneurysm volume correlated well with the diameter (r=0.77, p<0.01), the intraluminal thrombus volume (ILT) showed the clearest correlation with the crural runoff (r=-0.34, p=0.01). No correlation between the diameter and crural runoff was observed (r=-0.17, p=0.1). A reduced crural run-off was significantly associated with impaired amputation-free survival (p=0.01). A subgroup analysis (n=21) with sequential CTs showed a tendency towards greater increase of thrombus volume compared to plain diameter during PAA growth. The thrombus volume index (=ILT/total PAA volume) was significantly higher in emergency patients (p=0.01), while diameters tended to be smaller (p=0.57). Conclusions: The increasing intraluminal thrombus volume correlates most distinctly with a reduced crural runoff in PAAs and should therefore be considered prognostically important, especially in the presence of an increased growth rate compared to the diameter.

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来源期刊
CiteScore
3.90
自引率
11.10%
发文量
61
审稿时长
1 months
期刊介绍: Vasa is the European journal of vascular medicine. It is the official organ of the German, Swiss, and Slovenian Societies of Angiology. The journal publishes original research articles, case reports and reviews on vascular biology, epidemiology, prevention, diagnosis, medical treatment and interventions for diseases of the arterial circulation, in the field of phlebology and lymphology including the microcirculation, except the cardiac circulation. Vasa combines basic science with clinical medicine making it relevant to all physicians interested in the whole vascular field.
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