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The Journal of cardiovascular surgery 主动脉近端解剖结构与腹主动脉瘤大小的关系及其对新一代内移植物腔内修复术结果的影响。

影响因子：1.595 DOI：10.23736/S0021-9509.18.10001-2

作者： Karathanos C,Spanos K,Kouvelos G,Athanasoulas A,Koutsias S,Matsagkas M,Giannoukas AD 发表时间：2020-07-09 12:20:34

from：《JOURNAL OF CARDIOVASCULAR SURGERY》

keywords： Karathanos CSpanos KKouvelos GAthanasoulas AKoutsias SMatsagkas MGiannoukas AD

关键词：

Abstract

BACKGROUND:To assess the relation of abdominal aortic aneurysm (AAA) diameter with the proximal neck anatomy (PNA) hostility and to evaluate its impact on the endovascular aneurysm repair (EVAR) outcomes with the use of newer generation endografts. METHODS:Retrospective analysis of single institution's recorded data from February 2009 to April 2016. Patients' characteristics, comorbidities, aortic morphology, perioperative characteristics and outcomes were analyzed. In relation to AAA diameter 2 groups were identified: group A (50-55 mm) and group B (>55 mm). Hostile PNA was defined based on: neck diameter >28 mm, length <15 mm, angulation >60o, and circumferential thrombus and/or calcification >50%. The aortic neck scoring system was calculated. Multiple logistic regression analysis with a forward likelihood ratio method adjusted for age and gender was undertaken. RESULTS:Three hundred seventeen patients (96% males, mean age 72.4±9 years, 80% elective) were follow-up for a mean of 23.4 months (range, 3-86 months). No differences were observed in demographics and co-morbidities between the two groups (group A: 134, 42% vs. group B: 183, 58%). Hostile PNA was present in 147/317 (46%) patients and significantly more likely to be present in group B (P<0.001). In group B the aortic neck score was higher (P<0.001), the likelihood for having hostile PNA increased for neck diameter by 2.2-fold (OR 2.2, P=0.013, 95% CI: 1.18-4.03), length by 2.3-fold (OR 2.3, P=0.012, 95% CI: 1.20-4.51), angle by 4.8-fold (OR 4.8, P=0.002, 95% CI: 1.79-13.24) and presence of thrombus by 1.5-fold (OR 1.5, P=0.037, 95% CI: 1.45-10.34). No association existed for neck calcification (P=0.071). Technical success, adjunctive procedures, perioperative characteristics and outcomes were comparable in friendly and hostile PNAs. CONCLUSIONS:PNA hostility is more likely in AAA with diameter >55 mm but with the use of newer generation endografts this did not influence the short- and mid-term EVAR outcomes. Longer follow-up is needed for a more definite conclusion.

摘要

背景: 评估腹主动脉瘤 (AAA) 直径与近端颈部解剖 (PNA) 敌意的关系，并评估其对动脉瘤腔内修复术 (EVAR) 的影响使用新一代内移植物的结果。方法: 回顾性分析 2009 年 2 月至 2016 年 4 月单个机构的记录数据。分析患者特点、合并症、主动脉形态、围手术期特点及转归。关于AAA直径，确定了 2 组: A组 (50-55毫米) 和B组 (> 55毫米)。敌对PNA定义为: 颈部直径> 28毫米，长度 <15毫米，成角> 60o，环周血栓和/或钙化> 50%。计算主动脉颈部评分系统。采用校正年龄和性别的前向似然比方法进行多元logistic回归分析。结果: 96% 例患者 (72.4 例男性，平均年龄 80% ± 9 岁，23.4 例择期) 获得平均个月 (范围，3-86 个月) 的随访。两组在人口统计学和合并症方面没有观察到差异 (A组: 134，42% vs.B组: 183，58%)。147/317 (46%) 的患者存在敌对PNA，B组更可能存在 (P<0.001)。B组主动脉颈部评分较高 (P<0.001)，颈部直径有敌意PNA的可能性增加 2.2 倍 (OR 2.2，P = 0.013，95% CI: 1.18-4.03)，长度为 2.3 倍 (OR 2.3，P = 0.012，95% CI: 1.20-4.51)，角度为 4.8 倍 (OR 4.8，P = 0.002，95% CI: 1.79-13.24) 和 1.5 倍的血栓存在 (OR 1.5，P = 0.037，95% CI: 1.45-10.34)。颈部钙化不存在相关性 (P = 0.071)。技术成功、辅助手术、围手术期特征和结局在友好和敌对的PNAs中具有可比性。结论: PNA敌意在直径> 55毫米的AAA中更可能存在，但使用新一代内移植物时，这并不影响中短期EVAR结局。需要更长时间的随访才能得出更明确的结论。

期刊介绍

《JOURNAL OF CARDIOVASCULAR SURGERY》 (点击进入期刊详情)

英文简介 : A Journal on the Diagnosis and Therapy of Cardiac Thoracic and Vascular Diseases. Frequency: Bi-Monthly. Affiliated with the Society of Cardio-Thoracic Surgeons.

中文简介 : （来自Google、百度翻译）心胸血管疾病的诊断和治疗杂志。频率：双月。隶属于心胸外科医师协会。

CIRCULATION RESEARCH 期刊中科院评价数据

新中科院分区

大类(学科)	小类(学科)	学科排名
医学	CARDIAC & CARDIOVASCULAR SYSTEMS (心脏和心血管系统) PERIPHERAL VASCULAR DISEASE (外周血管病) SURGERY (外科)	110/128 59/65 145/200

大类(学科)

小类(学科)

学科排名

医学

CARDIAC & CARDIOVASCULAR SYSTEMS (心脏和心血管系统)

PERIPHERAL VASCULAR DISEASE (外周血管病)

SURGERY (外科)

110/128
59/65
145/200

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