Statin therapy is associated with aneurysm sac regression after endovascular aortic repair
Statin therapy is associated with aneurysm sac regression after endovascular aortic repair
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DOI：
10.1016/j.jvs.2011.12.040
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发表时间：
2012-06-01
影响因子：
4.3
通讯作者：
Becquemin, Jean-Pierre
中科院分区：
文献类型：
--
作者：
Raux, Maxime;Cochennec, Frederic;Becquemin, Jean-Pierre
背景：已经确定了几个解剖因素可预测腹主动脉瘤腔内修复术（EVAR）后的囊行为。他汀类药物治疗对动脉瘤囊缩小的影响仍存在争议。本研究检验了他汀类药物治疗增强腹主动脉瘤腔内修复术后瘤囊消退的假设。方法：本单中心回顾性研究纳入了使用Zenith（Cook，布卢明顿，印第安纳州）移植物器械行腹主动脉瘤腔内修复术的患者。我们排除了存在围手术期囊扩大因素（如内漏、内张力、感染性、炎性、破裂或吻合口动脉瘤）的患者。我们前瞻性评估了腹主动脉瘤腔内修复术时和随访期间的标准临床和解剖数据以及他汀类药物的使用。主要终点是减少在24个月的最大横向主动脉直径与术前diameter.Results相比：在166例患者治疗的Zenith设备，并符合纳入标准，120被确定为他汀类药物用户和46非他汀类药物用户，具有可比性的特点。在24个月的随访中，他汀类药物组患者的动脉瘤囊缩小率更高（25% vs 14%; P <0.0001）。在直径回缩阈值为5 mm时，他汀类药物的使用是回缩的积极因素（比值比，7.93; 95%置信区间，3.22-15.52; P < .0001）。多变量分析显示，他汀类药物的使用是瘤囊消退的独立预测因素（校正比值比，9.39; 95%置信区间，3.45-25.56）。结论：本研究表明，他汀类药物的使用可预测采用Zenith覆膜支架行腹主动脉瘤腔内修复术后的瘤囊消退。这种效应需要通过更大规模的随机试验或大规模人群评估来证实。（J Vasc Surg 2012; 55：1587-92.）
Background: Several anatomic factors have been identified as predictive of sac behavior after endovascular aneurysm repair (EVAR). The effects of statin therapy on aneurysm sac size reduction remain controversial. This study tested the hypothesis that statin therapy enhances aneurysmal sac regression after EVAR.Methods: This monocentric retrospective study included patients with abdominal aortic aneurysms treated by EVAR using the Zenith (Cook, Bloomington, Ind) graft device. We excluded patients presenting with perioperative sac enlargement factors such as endoleaks, endotension, infectious, inflammatory, ruptured, or anastomotic aneurysms. We prospectively assessed standard clinical and anatomic data, as well as statin use, at the time of EVAR and during follow-up. The primary end point was the decrease in the largest transverse aortic diameter at 24 months compared with the preoperative diameter.Results: Among 166 patients treated by a Zenith device and meeting the inclusion criteria, 120 were identified as statin users and 46 as nonstatin users, with comparable characteristics. At 24 months of follow-up, statin group patients had a greater aneurysm sac reduction (25% vs 14%; P < .0001). At a threshold of 5 mm in diameter regression, statin use was a positive factor of retraction (odds ratio, 7.93; 95% confidence interval, 3.22-15.52; P < .0001). Multivariate analysis revealed statin use was an independent predictive factor of sac regression (adjusted odds ratio, 9.39; 95% confidence interval, 3.45-25.56).Conclusions: This study showed that statin use was predictive of sac regression after EVAR with the Zenith graft device. This effect needs to be confirmed by larger randomized trials or by large population evaluation. (J Vasc Surg 2012; 55: 1587-92.)