A modern experience with saccular aortic aneurysms
A modern experience with saccular aortic aneurysms
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DOI：
10.1016/j.jvs.2012.07.002
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发表时间：
2013-01-01
影响因子：
4.3
通讯作者：
Jackson, Benjamin M.
中科院分区：
文献类型：
--
作者：
Shang, Eric K.;Nathan, Derek P.;Jackson, Benjamin M.
目的：囊状主动脉瘤（SAA）的修复经常建议的基础上感知的倾向破裂，尽管很少有证据表明，这些动脉瘤有一个更恶性的自然史比梭形aortic aneurysm.Methods：在一个单一的大学医院的放射学数据库中搜索的SAA的计算机断层扫描（CT）诊断2003年至2011年。记录患者特征和临床病程，包括手术干预的需要。通过随访CT评估SAA进展（如适用）。多变量分析被用来检查潜在的预测动脉瘤的生长rate.Results：322囊状主动脉瘤被确定在284例患者。男性153例（53.7%），女性131例，平均年龄73.5 ± 10.0岁。SAA位于升主动脉2例（0.6%），主动脉弓23例（7.1%），胸降主动脉219例（68.1%），腹主动脉78例（24.2%）。113例（39.8%）患者接受了SAA手术修复。62例患者（54.9%）接受胸主动脉腔内修复术，22例患者（19.5%）接受动脉瘤腔内修复术，29例患者（25.6%）需要开放手术。SAA的平均最大直径为5.0 ± 1.6 cm。在修复的动脉瘤中，平均直径为5.4 ± 1.4 cm;在未修复的动脉瘤中，平均直径为4.4 ± 1.1 cm（P <0.001）。11名患者（3.9%）在初次扫描时出现SAA破裂。在最初的284例患者中，50例患者（54例SAA）在至少3个月（23.2 +/- 19.0个月）后接受了CT随访。15例患者（30.0%）最终接受了手术干预。动脉瘤生长率为2.8 ± 2.9 mm/年，与初始主动脉直径仅弱相关（线性回归R-2 = 0.19，多变量回归P = 0.09）。降低钙负荷（P = 0.03）和增加患者年龄（P = 0.05）预测增加动脉瘤生长的多变量analysis.Conclusions：虽然SAA没有发现有较高的增长率比梭形对应，临床和放射学随访是必要的，因为一个显着的数字最终需要手术干预。进一步的临床研究是必要的，以确定SAA的最佳管理。（J Vasc Surg 2013;57：84-8.）
Objective: Repair of saccular aortic aneurysms (SAAs) is frequently recommended based on a perceived predisposition to rupture, despite little evidence that these aneurysms have a more malignant natural history than fusiform aortic aneurysms.Methods: The radiology database at a single university hospital was searched for the computed tomographic (CT) diagnosis of SAA between 2003 and 2011. Patient characteristics and clinical course, including the need for surgical intervention, were recorded. SAA evolution was assessed by follow-up CT, where available. Multivariate analysis was used to examine potential predictors of aneurysm growth rate.Results: Three hundred twenty-two saccular aortic aneurysms were identified in 284 patients. There were 153 (53.7%) men and 131 women with a mean age of 73.5 +/- 10.0 years. SAAs were located in the ascending aorta in two (0.6%) cases, the aortic arch in 23 (7.1%), the descending thoracic aorta in 219 (68.1%), and the abdominal aorta in 78 (24.2%). One hundred thirteen (39.8%) patients underwent surgical repair of SAA. Sixty-two patients (54.9%) underwent thoracic endovascular aortic repair, 22 underwent endovascular aneurysm repair (19.5%), and 29 (25.6%) required open surgery. The average maximum diameter of SAA was 5.0 +/- 1.6 cm. In repaired aneurysms, the mean diameter was 5.4 +/- 1.4 cm; in unrepaired aneurysms, it was 4.4 +/- 1.1 cm (P < .001). Eleven patients (3.9%) had ruptured SAAs on initial scan. Of the initial 284 patients, 50 patients (with 54 SAA) had CT follow-up after at least 3 months (23.2 +/- 19.0 months). Fifteen patients (30.0%) ultimately underwent surgical intervention. Aneurysm growth rate was 2.8 +/- 2.9 mm/yr, and was only weakly related to initial aortic diameter (R-2 = .19 by linear regression, P = .09 by multivariate regression). Decreased calcium burden (P = .03) and increased patient age (P = .05) predicted increased aneurysm growth by multivariate analysis.Conclusions: While SAA were not found to have a higher growth rate than their fusiform counterparts, both clinical and radiologic follow-up is necessary, as a significant number ultimately require surgical intervention. Further clinical research is necessary to determine the optimal management of SAA. (J Vasc Surg 2013;57:84-8.)