복부 대동맥류의 혈관 내 치료 후의 동맥류 낭의 크기 감소에 관련된 새로운 예측 인자

Abstract

Background: The aims of this study were to identify new predictors of sac behavior after endovascular aortic aneurysm repair (EVAR) and to investigate whether the sac behavior is associated with long-term clinical outcomes. Methods and Results: A total of 168 patients undergoing successful EVAR for abdominal aortic aneurysms with computed tomography angiography (CTA) follow-up of at least 1 year were included. Predictors of aneurysm sac behavior and its impact on long-term clinical outcomes were retrospectively analyzed. According to the sac behavior, eligible patients were stratified into the sac regression group (n=79, 47.0%) and the sac expansion group (n=89, 53.0%). Patients in the sac regression group were younger (P=0.036) and more likely to take sarpogrelate hydrochloride at follow-up (P=0.011) than those in the sac expansion group. The incidence of postimplantation syndrome (PIS) was significantly higher in the sac regression group (P=0.005). On multivariate analysis, sac regression was more likely to occur in those with PIS (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.07–2.64; P=0.023) and less likely to occur in those with transient type II endoleaks (HR, 0.43; 95% CI, 0.20–0.95; P=0.037) and higher thrombus density within the sac on follow-up CTA (HR, 0.97; 95% CI, 0.95–0.99; P=0.013). Sac expansion was associated with significantly higher rates of reintervention during the follow-up period (P=0.001). Conclusions: In addition to type II endoleaks, PIS and thrombus density are new predictors of aneurysm sac behavior, and sac regression is significantly associated with lower rates of reintervention.