European Journal of Vascular and Endovascular Surgery最新文献

Objective: Low estimated glomerular filtration rate (eGFR) increases the risk of arterial diseases, possibly including abdominal aortic aneurysm (AAA). This study explored the relationship between eGFR (2008 CKD-EPI equation), annual eGFR decline, and subsequent risk of developing AAA in a large, community based sample.

Methods: This was an observational study using complete healthcare records of Stockholm residents free from AAA who underwent routine creatinine testing during 2011 - 2021. Cox regression, adjusted for age, sex, comorbidities, and ongoing medications, was used to analyse the association between a single point eGFR or the change in eGFR within a year and the rate of both a de novo AAA diagnosis (both intact and ruptured) and fatal AAA (i.e., AAA followed by death within 30 days).

Results: The study included 1 586 410 participants (mean age 48 years; 53% female; median eGFR 96 mL/min/1.73 m²). During a median follow up of 7.6 years, 5 313 participants (0.34%) experienced AAA, of which 321 (0.02%) were fatal. In multivariable analyses, compared with eGFR 90 mL/min/1.73 m², the rates of AAA events were higher across lower eGFR: for eGFR 30 mL/min/1.73 m², the hazard ratio (HR) of AAA was 1.24 (95% confidence interval [CI] 1.09 - 1.40) and of fatal AAA was 2.51 (95% CI 1.67 - 3.75); for eGFR 15 mL/min/1.73 m², the HR of AAA was 1.49 (95% CI 1.19 - 1.86) and of fatal AAA was 3.73 (95% CI 2.04 - 6.81). When analysed separately, the results were similar for intact and ruptured AAA risk. Among the 638 959 participants who had repeated eGFR tests, 3 447 (0.54%) experienced AAA events, of which 217 (0.04%) were fatal. Compared with stable eGFR (change -1 to 1 mL/min/year), the rate of AAA events was 15% higher (HR 1.15, 95% CI 1.05 - 1.26) in participants with an eGFR decline of 1 to 3 mL/min/year and 46% higher (HR 1.46, 95% CI 1.16 - 1.84) in those with an eGFR decline of > 3 mL/min/year.

Conclusion: In this observational study, both a single point eGFR and a faster eGFR decline were associated with the risk of experiencing AAA. The incidence rate of AAA, and particularly fatal AAA, was higher in individuals with greater severity of chronic kidney disease or faster eGFR decline.

Objective: Creation of a basilic vein arteriovenous transposition fistula (BBAVF) can be performed either as a one or two stage procedure; however, evidence for the best technique is conflicting. The aim of this national registry review was to determine whether functional outcomes favoured either method.

Methods: This was an observational retrospective study with data from the Swedish Renal Registry. BBAVFs created in patients aged ≥ 18 years in 2011 - 2019 were included and were categorised as one stage (BB1) or two stage (BB2). Outcome, patency, and complications were captured from creation onwards, as were all open and endovascular repeat procedures.

Results: BB1s (n = 224) were more common than BB2s (n = 83). Of the BB2s, 66 (80%) were transposed in the second stage. The most common reason for not performing transposition was occlusion (n = 10). Median follow up time was 2 years (interquartile range [IQR] 0.8, 4.2). Overall, 31% of BBAVFs were never used. Vein stenosis was common, seen in 157 BB1s (70%) and 40 BB2s (48%). The incidence of endovascular interventions per patient year was two times higher in BB1s than BB2s (0.6 vs. 0.3). Primary patency at one year was 39% and 54% in BB1 and BB2, respectively (p = .002). Secondary patency at one and three years was similar between groups (BB1 81% and 69%, and BB2 82% and 78%; p = .14). Diabetes as a comorbidity and female sex were associated with worse patency, but body mass index ≥ 30 kg/m² was not. Creation pre-dialysis did not affect patency. The median time from creation to first puncture was 73 days (IQR 51, 157) and 141 days (IQR 105, 225) for BB1 and BB2, respectively.

Conclusion: The two stage method had superior primary patency, counterbalanced by two operations. Long term patency was equivalent for the two surgical techniques. The incidence of endovascular re-interventions was high, and BBAVFs were less usable in females and patients with diabetes as a comorbidity.