目的:腔内主动脉修复术(EVAR)作为感染性天然主动脉瘤(INAA)的外科治疗,与开放手术相比,其生存率更高。但有感染相关并发症(IRC)的风险。本研究旨在评估接受EVAR治疗的INAA患者的基线临床和计算机断层扫描(CT)特征与术后IRC风险之间的关系。它还试图开发一种模型来预测接受EVAR治疗的腹部INAA患者的长期IRC。
方法:回顾性分析了2005年至2020年在一家主要转诊医院进行的所有初始临床细节和CT检查。根据动脉瘤特征仔细检查图像,以及主动脉周围和周围器官受累。在患者记录中发现了术后IRC的数据。Cox回归分析用于得出IRC的预测因子,并建立一个模型来预测腹部INAAEVAR后五年的IRC。
结果:在3780例诊断为主动脉瘤或主动脉炎的患者中,98例(3%)患者接受EVAR治疗腹部INAA,因此被纳入。平均随访时间为52个月(范围0〜163)。平均经轴直径为6.5±2.4cm(范围2.1-14.7)。在登记的患者中,38(39%)出现破裂。腹部INAAs的五年IRC率为26%。女性性别,肾功能不全,血培养阳性,动脉瘤直径,和腰大肌受累是EVAR后腹部INAA五年IRC的预测因素。该模型的C指数为0.76(95%CI0.66-0.87)。
结论:术前临床和CT特征有可能预测INAA患者血管内主动脉修复术后的IRC。这些发现强调了严格临床的重要性,实验室,对这些患者进行放射学随访。
Endovascular aortic repair (EVAR) as surgical treatment for infective native aortic aneurysm (INAA) is associated with superior survival compared with open surgery, but with the risk of infection related complications (IRCs). This study aimed to assess the association between baseline clinical and computed tomography (CT) features and the risk of post-operative IRCs in patients treated with EVAR for INAA. It also sought to develop a model to predict long term IRCs in patients with abdominal INAA treated with EVAR.
All initial clinical details and CT examinations of INAAs between 2005 and 2020 at a major referral hospital were reviewed retrospectively. The images were scrutinised according to aneurysm features, as well as peri-aortic and surrounding organ involvement. Data on post-operative IRCs were found in the patient records. Cox regression analysis was used to derive predictors for IRCs and develop a model to predict five year IRCs after EVAR in abdominal INAA.
Of 3 780 patients with the diagnosis of aortic aneurysm or aortitis, 98 (3%) patients were treated with EVAR for abdominal INAAs and were thus included. The mean follow up time was 52 months (range 0 ‒ 163). The mean transaxial diameter was 6.5 ± 2.4 cm (range 2.1 ‒14.7). In the enrolled patients, 38 (39%) presented with rupture. The five year IRC rate in abdominal INAAs was 26%. Female sex, renal insufficiency, positive blood culture, aneurysm diameter, and psoas muscle involvement were predictive of five year IRC in abdominal INAA after EVAR. The model had a C-index of 0.76 (95% CI 0.66 - 0.87).
Pre-operative clinical and CT features have the potential to predict IRC after endovascular aortic repair in INAA patients. These findings stress the importance of rigorous clinical, laboratory, and radiological follow up in these patients.