Reduced pulsatile wall motion of abdominal aortic aneurysms after endovascular repair
Reduced pulsatile wall motion of abdominal aortic aneurysms after endovascular repair
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DOI：
10.1016/s0741-5214(98)70226-5
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发表时间：
1998-04-01
影响因子：
4.3
通讯作者：
Brunkwall, J
中科院分区：
文献类型：
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作者：
Malina, M;Länne, T;Brunkwall, J
目的：腔内修复术后腹主动脉瘤（AAA）尺寸减小表明动脉瘤内压降低。在存在内漏的情况下，尺寸不会减小。虽然术后动脉瘤内压力难以记录，但动脉瘤的搏动性室壁运动（PWM）可以无创测量。本研究的目的是评估腹主动脉瘤腔内修复术前后的PWM，并将PWM的变化与动脉瘤的大小和内漏的存在联系起来。在术前、1、3和6个月以及此后每半年使用超声回波跟踪扫描测量动脉瘤直径和PWM。15个动脉瘤发生内漏，而32个被完全排除。使用计算机断层扫描和血管造影术表征泄漏。结果：术前动脉瘤宽度为0.8 ~ 1.3 mm，平均1.0 mm。完全腔内隔绝术后，PWM为术前值的25%（范围，16%至37%）（p < 0.001），动脉瘤直径减小8 mm（范围，6至14 mm）（p < 0.001）。18个月后，没有发生进一步的直径减小。在3例无内漏但动脉瘤扩大的患者中，术后PWM显示减少较少（p < 0.05）。有内漏的动脉瘤无直径缩小，术后PWM比完全排除的病例高50%（p < 0.01）。在5例一过性内漏患者中，泄漏停止后PWM I降低（p < 0.05）。结论：腔内修复术后动脉瘤的大小和脉宽减小。直径减小可能在1.5年后停止。内漏与高于预期的PWM相关。压力可以在没有泄漏迹象的情况下传输。
Purpose: The reduced size of abdominal aortic aneurysms (AAAs) after endovascular repair suggests lowered intraaneurysmal pressure. In the presence of endoleaks, the size is not decreased. Although postoperative intraaneurysmal pressure is difficult to record, the pulsatile wall motion (PWM) of aneurysms can be measured noninvasively. The aim of this study was to assess the PWM of AAAs before and after endovascular repair and to relate the change in the PWM to aneurysmal size and presence of endoleaks.Methods: Forty-seven patients underwent endovascular repair of an AAA. The aneurysm diameter and PWM were measured with the use of ultrasonic echo-tacking scans preoperatively; at 1, 3, and 6 months; and thereafter biannually. Fifteen aneurysms developed endoleaks, whereas 32 were completely excluded. The leaks were characterized with the use of computed tomographic scanning and angiography. Median follow-up was 12 months (interquartile range, 5 to 24 months).Results: The preoperative PWM of the aneurysms was 1.0 mm (range, 0.8 to 1.3 mm). After complete endovascular exclusion, the PWM was 25% (range, 16% to 37%) of the preoperative value (p < 0.001), and aneurysm diameter decreased by 8 mm (range, 6 to 14 mm) (p < 0.001). After 18 months, no further diameter reduction occurred. In three patients without endoleaks but with enlarging aneurysms, the postoperative PWM showed less reduction (p < 0.05). Aneurysms with endoleaks showed no diameter decrease, and the postoperative PWM was 50% higher than that in the totally excluded cases (p < 0.01). In five patients with transient endoleaks, the PWM I was reduced after leakage ceased (p < 0.05). Leaks of various sources displayed similar PWM.Conclusion: The size and PWM of aneurysms are reduced after endovascular repair. The diameter reduction may cease after 1.5 years. Endoleaks are associated with higher PWM than expected. Pressure may be transmitted without evidence of leaks.