How Quickly Do Asymptomatic Infrarenal Abdominal Aortic Aneurysms Grow and What Factors Affect Aneurysm Growth Rates? Analysis of a Single Centre Surveillance Cohort Database.
How Quickly Do Asymptomatic Infrarenal Abdominal Aortic Aneurysms Grow and What Factors Affect Aneurysm Growth Rates? Analysis of a Single Centre Surveillance Cohort Database.
复制标题
无症状肾下腹主动脉瘤生长速度有多快以及哪些因素影响动脉瘤生长速度？
DOI：
10.1016/j.ejvs.2017.08.002
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
A. Bradbury
中科院分区：
文献类型：
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作者：
Mehtab Ahmad;R. Mistry;J. Hodson;A. Bradbury
目的/背景腹主动脉瘤（AAA）最大前后直径（MAPD）是最常用于告知手术干预时机的参数。然而，其他因素，如增长率和患者的合并症可能是重要的考虑因素，因为它们可能会影响AAA相关的并发症，包括破裂，手术结果，和临床和成本效益的持续surveillance.MethodsThis是一个回顾性分析20年期间的一个单一的中心AAA监测数据库。总共，5363 AAA测量692例患者进行了分析，患者的人口统计学资料，包括合并症和药物史，生长和破裂率，和causeofdeath.ResultsA显着比例的患者（n= 73; 11%），尽管有一个MAPD < 30 mm的监测。总体而言，平均动脉瘤生长率为2.3 mm/年。20.1%进行了选择性修复，需要手术干预的患者生长速度明显更快。监测组中只有3.9%的患者发生了破裂，其中40.7%的患者在最后一次扫描时MAPD <55 mm。在记录的214例死亡中，只有11.7%与AAA有关。在监测中死亡的大多数患者是死于恶性肿瘤。进入监测时AAA较大（MAPD > 40 mm）的患者更有可能接受手术干预，AAA扩张>4 mm/年的患者也是如此。女性的生长速度明显更高，而糖尿病患者的生长速度明显更低。其他合并症和药物史与AAA的增长，或5年和10年的手术免费survival.ConclusionThe结果突出了几个领域的服务改进。特别是，对于那些由于年龄和/或合并症而不太可能生长到考虑进行AAA手术的患者，不要保持监测是很重要的。同样，当这种可能性变得明显时，患者应停止监测。
Objective/BackgroundAbdominal aortic aneurysm (AAA) maximum antero-posterior diameter (MAPD) is the parameter most commonly used to inform the timing of surgical intervention. However, other factors, such as growth rates and patient comorbidities are likely to be important considerations as they may influence AAA related complications including rupture, operative outcomes, and the clinical and cost effectiveness of continued surveillance.MethodsThis was a retrospective analysis of a 20 year period of a single centre AAA surveillance database. In total, 5363 AAA measurements in 692 patients were analysed for patient demographics, including comorbidity and drug history, growth and rupture rates, and cause of death.ResultsA significant proportion of patients (n= 73; 11%) were kept under surveillance despite having a MAPD < 30 mm. Overall, mean aneurysm growth rate was 2.3 mm/year. Elective repair was undertaken in 20.1% and those who required surgical intervention had significantly faster growth rates. Only 3.9% of patients in surveillance ruptured, 40.7% of whom had a MAPD <55 mm at their last scan. Of the 214 deaths recorded, only 11.7% were related to AAA. The majority of patients who died in surveillance did so from malignancy. Patients with larger AAA (MAPD > 40 mm) on entry into surveillance were significantly more likely to receive surgical intervention, as were those whose AAA expanded >4 mm/year. Females had significantly higher growth rates, and those with diabetes had significantly smaller growth rates. Other comorbidities and drug history were not associated with AAA growth, or 5 and 10 year surgery free survival.ConclusionThe results highlight several areas for service improvement. Specifically, it is important not to maintain surveillance in patients who are very unlikely to ever grow to a point where AAA surgery would be contemplated on grounds or age and/or comorbidity. Similarly, patients should be discharged from surveillance when this likelihood becomes apparent.