Presence of Atherosclerosis in Multiple Arterial Beds is Associated with Increased Mortality in Patients Undergoing Endovascular Aortic Aneurysm Repair.

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE European Journal of Vascular and Endovascular Surgery Pub Date : 2024-10-10 DOI:10.1016/j.ejvs.2024.10.004

Molly Ratner, Heepeel Chang, Caron B Rockman, Benjamin J Pearce, Jeffrey J Siracuse, Jae S Cho, Neal Cayne, Thomas Maldonado, Virendra Patel, Karan Garg

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Abstract

Objective: Patients with polyvascular disease are considered high risk for major adverse cardiac events (MACEs). This retrospective study utilised the Vascular Quality Initiative (VQI) database to quantify the effect of polyvascular disease on outcomes after endovascular aneurysm repair (EVAR).

Methods: The VQI database was queried from to 2012 - 2022 for elective EVAR. Patients were identified as having peripheral arterial disease, coronary artery disease, or cerebrovascular disease, and then stratified based on the number of arterial beds involved (one to three). Primary outcomes were peri-operative death and MACEs. Multivariate analysis was performed to find associations between comorbidities and primary outcomes.

Results: Of the 21 160 patients with arterial disease included in the study, 83.7% were male and the mean age was 73.73 ± 8.57 years. After stratification, 16 892 patients had atherosclerosis in one arterial bed, 3 869 in two arterial beds, and 399 in three arterial beds. Pre-operatively, patients with atherosclerosis in three arterial beds were more likely to have hypertension, diabetes, and renal failure (all p < .001). Post-operatively, patients with disease in three arterial beds were more likely to experience a post-operative complication (11.5% vs. 8.3% vs. 5.4%; p < .001), including MACE (4.6% vs. 4.1% vs. 2.8%; p < .001) and death (3.0% vs. 2.5% vs. 1.7%; p < .010). On multivariate analysis, polyvascular disease was associated with MACEs (odds ratio 1.54, 95% confidence interval 1.29 - 1.84; p < .001). Kaplan-Meier analysis estimates showed statistically significant differences in survival at approximately the three year follow up (p < .001).

Conclusion: In this review of patients undergoing elective EVAR, patients with polyvascular disease experienced worse peri-operative outcomes, including death and MACEs, the latter of which was confirmed on multivariable analysis. These patients should be considered high risk and managed accordingly.

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多动脉床动脉粥样硬化与接受血管内主动脉瘤修补术的患者死亡率增加有关。

目的：多血管疾病患者被认为是主要心脏不良事件（MACE）的高风险人群。这项回顾性研究利用血管质量倡议（VQI）数据库来量化多血管疾病对血管内动脉瘤修补术（EVAR）后预后的影响：方法：对2012-2022年期间的择期EVAR患者进行VQI数据库查询。确定患者患有外周动脉疾病、冠状动脉疾病或脑血管疾病，然后根据受累动脉床的数量（一至三个）进行分层。主要结果是围手术期死亡和MACE。对合并症与主要结果之间的关系进行了多变量分析：在21 160名动脉疾病患者中，83.7%为男性，平均年龄为（73.73±8.57）岁。经过分层后，16 892 名患者的动脉粥样硬化位于一个动脉床，3 869 名患者的动脉粥样硬化位于两个动脉床，399 名患者的动脉粥样硬化位于三个动脉床。术前，三个动脉床有动脉粥样硬化的患者更有可能患有高血压、糖尿病和肾功能衰竭（均 p < .001）。术后，三个动脉床有病变的患者更有可能出现术后并发症（11.5% vs. 8.3% vs. 5.4%；P < .001），包括MACE（4.6% vs. 4.1% vs. 2.8%；P < .001）和死亡（3.0% vs. 2.5% vs. 1.7%；P < .010）。多变量分析显示，多血管疾病与MACEs相关（几率比1.54，95% 置信区间1.29 - 1.84；P < .001）。卡普兰-梅耶尔分析估计结果显示，大约三年的随访生存率存在显著统计学差异（P < .001）：结论：在这项对接受择期EVAR手术的患者进行的回顾性研究中，患有多血管疾病的患者围手术期的预后较差，包括死亡和MACE，后者在多变量分析中得到证实。这些患者应被视为高危人群并进行相应的管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.