Effects of Chronic Obstructive Pulmonary Disease on the Outcomes of Fenestrated-Branched Endovascular Aortic Aneurysm Repair.

IF 2.8 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CardioVascular and Interventional Radiology Pub Date : 2024-11-01 Epub Date: 2024-10-15 DOI:10.1007/s00270-024-03884-w

Felipe L Pavarino, Mira T Tanenbaum, Andres V Figueroa, Carla K Scott, Alejandro Pizano, Jesus Porras-Colon, Anna L Driessen, Gerardo G Guardiola, Mirza S Baig, Carlos H Timaran

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Abstract

Purpose: Chronic obstructive pulmonary disease (COPD) is common in patients with aortic aneurysms. Severe COPD is associated with an increased risk of aneurysm rupture and perioperative complications. This study assesses the outcomes of COPD and non-COPD patients after fenestrated-branched endovascular aortic aneurysm repair (FBEVAR).

Materials and methods: A single institution, retrospective study of FBEVAR patients between 2011 and 2020 compared outcomes between COPD and non-COPD patients. COPD patients were stratified by Global Initiative for Chronic Obstructive Lung Disease criteria and oxygen dependence. Outcome measures included 30-day mortality, pulmonary complications, major adverse events (MAE), and mid-term survival.

Results: 387 patients (71% male, age 72 years, interquartile range [68-79]) underwent FBEVAR. 181 patients (47%) had COPD. Smoking history was more frequent in COPD patients (P = .022). Among COPD patients, 20.4% were oxygen-dependent. Technical success, defined as successful delivery of the main aortic endograft and all intended side branches, was 98.4%. 30-day mortality (P = .83) and MAE rates (P = .87) were similar between groups. While not statistically significant, COPD patients had more frequent pulmonary complications (6.1% vs. 2.4%, P = .13) and were more frequently discharged on oxygen (P = .002). There were no differences in intensive care unit or hospital length of stay between groups (P = .29; P = .85, respectively). 5-year survival was similar between groups (P = .10). Oxygen-dependent COPD and severe-very severe COPD were associated with decreased mid-term survival (Hazard Ratio 2.39, P = .048).

Conclusions: FBEVAR is safe and effective for treating complex aortic pathology in COPD patients, including oxygen-dependent patients. Patients with more severe COPD were more frequently discharged on oxygen. Mid-term survival was slightly reduced in patients with oxygen-dependent and severe-very severe COPD.

Level of evidence: Level 3, non-randomized controlled cohort/follow-up study.

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慢性阻塞性肺病对血管内主动脉瘤修补术效果的影响

目的：慢性阻塞性肺疾病（COPD）在主动脉瘤患者中很常见。严重的慢性阻塞性肺疾病会增加动脉瘤破裂和围手术期并发症的风险。本研究评估了慢性阻塞性肺病和非慢性阻塞性肺病患者在进行开孔-分支血管内主动脉瘤修补术（FBEVAR）后的疗效：一项针对 2011 年至 2020 年期间 FBEVAR 患者的单一机构回顾性研究比较了慢性阻塞性肺病患者和非慢性阻塞性肺病患者的治疗效果。根据全球慢性阻塞性肺病倡议标准和氧依赖性对慢性阻塞性肺病患者进行了分层。结果指标包括30天死亡率、肺部并发症、主要不良事件（MAE）和中期生存率：387名患者（71%为男性，年龄72岁，四分位数间距[68-79]）接受了FBEVAR手术。181名患者（47%）患有慢性阻塞性肺病。COPD 患者中吸烟史较多（P = .022）。在慢性阻塞性肺病患者中，有 20.4% 的患者需要依赖氧气。技术成功率为 98.4%，即成功输送主主动脉内膜移植物和所有预定侧支。两组患者的 30 天死亡率（P = .83）和 MAE 率（P = .87）相似。虽然没有统计学意义，但慢性阻塞性肺病患者的肺部并发症发生率更高（6.1% 对 2.4%，P = .13），出院时吸氧的频率更高（P = .002）。两组患者在重症监护室或住院时间上没有差异（P = 0.29；P = 0.85）。两组患者的 5 年生存率相似（P = .10）。氧依赖性慢性阻塞性肺病和重度-极重度慢性阻塞性肺病与中期存活率下降有关（危险比 2.39，P = .048）：结论：FBEVAR可安全有效地治疗慢性阻塞性肺病患者（包括氧依赖患者）的复杂主动脉病变。结论：FBEVAR 对慢性阻塞性肺病患者（包括氧气依赖患者）的复杂主动脉病变治疗安全有效。有氧依赖和重度-极重度慢性阻塞性肺病患者的中期存活率略有下降：证据级别：3级，非随机对照队列/随访研究。

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来源期刊

CardioVascular and Interventional Radiology 医学-核医学

CiteScore

5.50

自引率

13.80%

发文量

306

审稿时长

3-8 weeks

期刊介绍： CardioVascular and Interventional Radiology (CVIR) is the official journal of the Cardiovascular and Interventional Radiological Society of Europe, and is also the official organ of a number of additional distinguished national and international interventional radiological societies. CVIR publishes double blinded peer-reviewed original research work including clinical and laboratory investigations, technical notes, case reports, works in progress, and letters to the editor, as well as review articles, pictorial essays, editorials, and special invited submissions in the field of vascular and interventional radiology. Beside the communication of the latest research results in this field, it is also the aim of CVIR to support continuous medical education. Articles that are accepted for publication are done so with the understanding that they, or their substantive contents, have not been and will not be submitted to any other publication.