Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation.
Utility of a Simplified Iliac Artery Calcium Scoring System to Guide Perioperative Management for Renal Transplantation.
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DOI：
10.3389/fmed.2021.606835
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发表时间：
2021
影响因子：
3.9
通讯作者：
Hiramoto JS
中科院分区：
文献类型：
--
作者：
Werlin EC;Braun HJ;Walker JP;Freise JE;Amara D;Liu IH;Mello A;Tavakol M;Stock PG;Hiramoto JS
腹部和骨盆的非对比CT扫描(CTAP)通常是在肾移植前获得的，以评估髂动脉并帮助指导外科植入。这项研究的目的是使用简化的评分系统描述髂骨钙化评分与手术和临床结果的关系。对2013年1月至2014年11月行肾移植且移植前3年内行CTAP的204例患者进行了回顾性研究。数据是从电子病历中收集的。使用简单的评分系统评估CTAP上的髂总动脉(CIA)和髂外动脉(EIA)的钙化程度。进行描述性统计、Logistic回归和生存分析。共有204名患者被纳入分析。平均年龄57.4±11.2岁，男性134/204(66%)。19例(9%)有外周动脉病史(PAD)，78例(38%)有冠状动脉疾病，22例(11%)既往有脑血管意外(CVA)。有严重右EIA斑块形态的患者比无严重斑块的患者更有可能需要动脉重建(3/14[21%]4/153[3%]，p=0.03)。11名患者(5%)在移植后接受了一次或多次截肢(脚趾、足部或胫骨)。在UV Logistic回归分析中，重度EIA斑块形态(OR8.1，CI2.2~29.6，p=0.002)和PAD(OR10.7，CI2.8~39.9，p=0.0004)与截肢几率增加有关。在包含这两个变量的MV模型中，EIA斑块形态(OR 4.4，CI 0.99~18.3，p=0.04)和PAD(OR 6.3，CI 1.4~26.4，p=0.01)仍然与截肢几率增加独立相关。中位随访时间为3.3年(IQR 2.9-3.6)，21例(10%)患者术后发生主要不良心脏事件(MACE，定义为心肌梗死、冠状动脉介入治疗或CVA)，23例患者(11%)死亡。在未调整的Kaplan Meier分析中，CIA斑块(p=0.00081)和>；75%CIA长度钙化(p=0.0015)与MACE显著相关。EIA中的斑块负荷与术中动脉重建和术后下肢截肢的需求增加有关，而CIA斑块与术后MACE相关。在高危患者移植前CT扫描中评估CIA和EIA钙化评分可以指导手术策略和围手术期处理，以改善临床结果。
Non-contrast computed tomography scans of the abdomen and pelvis (CTAP) are often obtained prior to renal transplant to evaluate the iliac arteries and help guide surgical implantation. The purpose of this study was to describe the association of iliac calcification scores with operative and clinical outcomes using a simplified scoring system. A retrospective review of 204 patients who underwent renal transplant from 1/2013 to 11/2014 and who had a CTAP within 3 years prior to transplant was performed. Data were collected from the electronic medical record. Common iliac artery (CIA) and external iliac artery (EIA) calcification on CTAP were assessed using a simple scoring system. Descriptive statistics, logistic regression, and survival analyses were performed. A total of 204 patients were included in the analysis. The mean age was 57.4 ± 11.2 years and 134/204 (66%) were men. Nineteen patients (9%) had a history of peripheral artery disease (PAD), 78 (38%) had coronary artery disease, and 22 (11%) had a previous cerebrovascular accident (CVA). Patients with severe right EIA plaque morphology were significantly more likely to require arterial reconstruction compared to those without severe plaque (3/14[21%] 4/153 [3%], p = 0.03). Eleven patients (5%) had one or more amputations (toe, foot, or transtibial) following transplant. In UV logistic regression, severe EIA plaque morphology (OR 8.1, CI 2.2–29.6, p = 0.002) and PAD (OR 10.7, CI 2.8–39.9, p = 0.0004) were associated with increased odds of amputation. In the MV model containing both variables, EIA plaque morphology (OR 4.4, CI 0.99–18.3, p = 0.04) and PAD (OR 6.3, CI 1.4–26.4, p = 0.01) remained independently associated with increased odds of amputation. Over a median follow up of 3.3 years (IQR 2.9–3.6), 21 patients (10%) had post-operative major adverse cardiac events (MACE, defined as myocardial infarction, coronary intervention, or CVA), and 23 patients died (11%). In unadjusted Kaplan Meier analysis, CIA plaque (p = 0.00081) and >75% CIA length calcification (p = 0.0015) were significantly associated with MACE. Plaque burden in the EIA is associated with increased need for intra-operative arterial reconstruction and post-operative lower extremity amputations, while CIA plaque is associated with post-operative MACE. Assessment of CIA and EIA calcification scores on pre-transplant CT scans in high risk patients may guide operative strategy and perioperative management to improve clinical outcomes.
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影响因子：
6.6
作者：
Droupy, S;Eschwège, P;Benoit, G
通讯作者：
Benoit, G
影响因子：
5
作者：
Davis, Bradley;Marin, Daniele;Kim, Charles Y.
通讯作者：
Kim, Charles Y.
影响因子：
13.6
作者：
Snyder, JJ;Kasiske, BL;Maclean, R
通讯作者：
Maclean, R
影响因子：
13.6
作者：
Lentine, KL;Brennan, DC;Schnitzler, MA
通讯作者：
Schnitzler, MA
影响因子：
6.2
作者：
Brar, Amarpali;Jindal, Rahul M.;Salifu, Moro O.
通讯作者：
Salifu, Moro O.