肺动脉状态和糖尿病对腹主动脉瘤血管内修复术后主动脉颈扩张的影响:一份欧洲之星报告

N. Diehm, R. Hobo, I. Baumgartner, D. Do, H. Keo, C. Kalka, F. Dick, J. Buth, J. Schmidli
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引用次数: 18

摘要

目的探讨肺功能受损(IPS)和糖尿病(DM)与选择性肾内动脉瘤修复(EVAR)术后临床结局及主动脉颈扩张和I型内陷发生率的关系。方法在164个欧洲机构参与EUROSTAR登记,6383例患者(5985名男性;平均年龄72.4±7.6岁)行EVAR。患者分为无IPS患者和无DM患者。分别于1、3、6、12、18和24个月及以后每年进行临床评估和增强CT检查。累积终点分析包括死亡、主动脉破裂、I型内漏、血管内再介入和手术转换。结果IPS患病率为2733/6383 (43%),DM患病率为810/6383(13%)。平均随访21.1+/-18.4个月。30天死亡率、AAA破裂和转归率在有IPS和没有IPS的患者之间以及有DM和没有DM的患者之间没有差异。与肺状态正常的患者相比,IPS患者的全因死亡率和AAA相关死亡率分别显著高于肺状态正常的患者(31.0%比19.0%,差值=15%),而支架移植类型的不同,IPS的存在与主动脉颈扩张率显著升高(30.6%比38.0%)无关。p>0.05),且不影响I型内漏、血管内再介入或转为开放手术的累积率(p>0.05)。同样,DM的存在也不影响上述研究终点。结论:与观察到的AAAs的自然过程相反,肺功能受损不会对主动脉颈扩张产生负面影响,而糖尿病的存在并不能避免EVAR后的这些令人沮丧的事件。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Influence of pulmonary status and diabetes mellitus on aortic neck dilatation following endovascular repair of abdominal aortic aneurysms: a EUROSTAR report.
PURPOSE To elucidate the association of impaired pulmonary status (IPS) and diabetes mellitus (DM) with clinical outcome and the incidences of aortic neck dilatation and type I endoleak after elective endovascular infrarenal aortic aneurysm repair (EVAR). METHODS In 164 European institutions participating in the EUROSTAR registry, 6383 patients (5985 men; mean age 72.4+/-7.6 years) underwent EVAR. Patients were divided into patients without versus with IPS or with/without DM. Clinical assessment and contrast-enhanced computed tomography (CT) were performed at 1, 3, 6, 12, 18, and 24 months and annually thereafter. Cumulative endpoint analysis comprised death, aortic rupture, type I endoleak, endovascular reintervention, and surgical conversion. RESULTS Prevalence of IPS was 2733/6383 (43%) and prevalence of DM was 810/6383 (13%). Mean follow-up was 21.1+/-18.4 months. Thirty-day mortality, AAA rupture, and conversion rates did not differ between patients with versus without IPS and between patients with versus without DM. All-cause and AAA-related mortality, respectively, were significantly higher in patients with IPS compared to patients with normal pulmonary status (31.0% versus 19.0%, p<0.0001 and 6.8% versus 3.3%, p = 0.0057) throughout follow-up. In multivariate analysis adjusted for smoking, age, gender, comorbidities, fitness for open repair, co-existing common iliac aneurysm, neck and aneurysm size, arterial angulations, aneurysm classification, endograft oversizing >or=15%, and type of stent-graft, the presence of IPS was not associated with significantly higher rates of aortic neck dilatation (30.6% versus 38.0%, p>0.05) and did not influence cumulative rates of type I endoleak, endovascular reintervention, or conversion to open surgery (p>0.05). Similarly, the presence of DM did not influence the above-mentioned study endpoints. CONCLUSION In contrast to observations regarding the natural course of AAAs, impaired pulmonary status does not negatively influence aortic neck dilatation, while the presence of diabetes does not protect from these dismal events after EVAR.
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