肌少症和ASA评分与t支装置治疗患者脊髓缺血的关系。

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Journal of Endovascular Therapy Pub Date : 2025-04-01 Epub Date: 2023-06-06 DOI:10.1177/15266028231179414
Tilo Kölbel, Petroula Nana, Jose I Torrealba, Giuseppe Panuccio, Christian-Alexander Behrendt, Konstantinos Spanos
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引用次数: 0

摘要

目的:肌少症已被确定为肾下腹主动脉瘤患者死亡率的独立预测因子,也可能影响复杂主动脉病变患者的预后。本研究的目的是评估肌肉减少症,结合美国麻醉医师协会(ASA)评分,作为t-Branch现成装置治疗的患者脊髓缺血(SCI)的预测因素。材料和方法:在2018年1月1日至2020年9月30日期间,对使用t-Branch装置(Cook Medical, bjaaeverskov, Denmark)管理的选择性和紧急患者进行了一项单中心回顾性观察研究。根据加强流行病学观察性研究报告(STROBE)声明收集数据。在术前ct血管造影的动脉期测量每位患者腰肌面积(cm2)和衰减(Hounsfield单位,HU)。采用瘦腰肌面积(leanpsoas muscle area, LPMA)将患者分为3组,并结合ASA评分和LPMA进一步分层。结果:纳入80例患者(平均年龄71±9岁;62.5%的男性)。胸腹动脉瘤在72.5%的病例中得到了治疗(42.5%为I-III型)。37例(46%)得到紧急治疗。11例患者在30天内死亡(14%)。12名患者(15%)表现为严重程度的脊髓损伤。LPMA组间,仅有年龄差异有统计学意义;与1组和2组相比,3组患者年龄更大(67.1岁vs 72.1岁vs 73.5岁,p=0.004)。ASA联合LPMA分型后,低危28例,中危16例,高危36例。低危组SCI发生率为3.5%[1/28],中危组为12.5%[2/16],高危组为25% [9/36],p=0.049)。多因素分析显示,中度风险患者有发展为脊髓损伤的风险(p=0.04)。结论:ASA评分为I-II或LPMA>350cm2HU的低危患者在使用t-Branch装置后发生脊髓损伤的风险较低。结合ASA评分和腰肌面积及衰减对患者进行分层,可以识别出支状血管内动脉瘤修复后发生SCI的高危人群。临床影响:骨骼肌减少症已被确定为动脉瘤修复患者死亡率增加的一个因素。然而,在评估其存在的工具中记录了显著的异质性。在本分析中,一种已经使用的方法,结合ASA评分和腰肌面积和衰减,被用来评估使用t分支装置治疗的患者肌肉减少症的影响。该分析显示,ASA评分为I-II或LPMA>350cm2HU的低风险患者发展为脊髓缺血的风险较低。沿着这条线,肌肉减少症可能是预测围手术期不良事件的一个有价值的标志,而不是死亡率,在使用复杂血管内修复的患者中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Association of Sarcopenia and ASA Score to Spinal Cord Ischemia in Patients Treated With the t-Branch Device.

Purpose: Sarcopenia has been identified as an independent predictor of mortality in patients with infrarenal abdominal aortic aneurysm and may also affect outcomes in patients with complex aortic pathologies. The aim of this study was to assess sarcopenia, combined with the American Society of Anesthesiologists (ASA) score, as predictors for spinal cord ischemia (SCI) in patients treated with the t-Branch off-the-shelf device.

Materials and methods: A single-center retrospective observational study was conducted including elective and urgent patients managed with the t-Branch device (Cook Medical, Bjaeverskov, Denmark) between January 1, 2018, and September 30, 2020. Data were collected according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. The psoas muscle area (cm2) and attenuation (Hounsfield units, HU) were measured in the arterial phase of the pre-operative computed tomography angiography for each patient. The lean psoas muscle area (LPMA) was used to stratify patients into 3 groups, and further stratification was performed with a combination of the ASA score and LPMA.

Results: Eighty patients were included (mean age at 71±9 years; 62.5% males). Thoracoabdominal aneurysms were managed in 72.5% of cases (42.5% for type I-III). Thirty-seven (46%) were treated urgently. Eleven patients died within 30 days (14%). Twelve patients (15%) presented SCI of any severity. Among the LPMA groups, the only statistically significant difference was recorded in age; group 3 was older compared with groups 1 and 2 (67.1 years vs 72.1 years vs 73.5 years, p=0.004). After ASA combined LPMA categorization, 28 patients were considered as low risk, 16 as moderate risk, and 36 as high risk. A statistically significant difference was recorded in terms of SCI (3.5% [1/28] in low risk vs 12.5% [2/16] in moderate risk vs 25% [9/36] in high risk, p=0.049). Multivariate analysis showed that moderate-risk patients were at risk to evolve to SCI (p=0.04).

Conclusions: Low-risk patients, with ASA score I-II or LPMA>350cm2HU, are at lower risk for developing SCI after BEVAR using the t-Branch device. Patients' stratification according to the combination of ASA score and psoas muscle area and attenuation may identify a group at higher risk of SCI after branched endovascular aneurysm repair.Clinical ImpactSarcopenia has been identified as a factor of increased mortality in patients managed for aortic aneurysm repair. However, significant heterogeneity has been recorded in the tools assessing its presence. In this analysis, an already used method, combining the ASA score and psoas muscle area and attenuation, has been used to assess the impact of sarcopenia in patients managed with the t-branch device. This analysis showed that patients at low risk, with an ASA score I-II or LPMA>350cm2HU were at lower risk to evolve spinal cord ischemia. Along this line, sarcopenia may be a valuable marker for the prediction of perioperative adverse events, other than mortality, in patients managed using complex endovascular repair.

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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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