Abdominal Aort Anevrizmalarına Yönelik Uygulanan Endovasküler Aort Tamiri Sonrası Mortalite ve Morbiditeye Etki Eden Faktörler

Abstract

Amaç: Endovasküler aort tamiri (EVAT) abdominal aort anevrizmalarında artan bir oranda cerrahi seçenek olarak uygyulanmaktadır. Minimal invazif bir prosedür olan EVAT işlemi sonrası mortalite ve morbiditeye etki eden faktörleri araştırdık.

Gereç ve Yöntemler: Eylül 2014 ile Ocak 2019 yılları arasında toplam 96 (91 E, 5 K) elektif EVAT uygulanmış hastalar çalışmaya dahil edildi. Ameliyat öncesi ve sonrası bilgisayarlı tomografi görüntüleri incelendi ve rutin kontroller ile takip edildi. Demografik faktörler, anevrizmanın anatomik özellikleri ve diğer risk faktörleri incelendi. Kaplan-Meier sağkalım analizi yapıldı. Cox regresyon analizi ile risk faktörlerinin mortalite ve morbiditedeki artış riski hesaplandı ve HR(hazard ratio) olarak değer belirtildi.

Bulgular: Ortalama takip süresi 27,45 ± 12,99 aydı. Aort boyun morfolojisin istatistiksel anlamlı olarak mortalite üzerine etkili olduğu görüldü (p değeri:0.046). Aort boyun açısı, sigara, perifer arter hastalığı(PAH), koroner arter hastalığı, kronik obstrüktif akciğer hastalığının bulunmasıyla mortalite üzerinde zarar görme riskinin yükseldiği görüldü (HR sırasıyla: 1,39; 1,45; 3,33; 1,84; 1,87; 3,60). Artmış kreatinin seviyesi (p değeri:0.003), kronik böbrek yetmezliği(p değeri:0.013), şeker hastalığı (p değeri: 0.038)’nın morbidite üzerinde istatistiksel olarak anlamlı olumsuz etkisi olduğu görüldü. Obezite ve PAH’nın morbidite üzerine zarar verme riskinin arttığı görüldü ( HR sırasıyla: 4,58; 1,61).

Sonuç: Bu çalışma bize hayatta kalımın ve morbiditenin EVAT sonrası, ameliyat öncesi ve sonrası faktörlerden etkilendiğini gösterdi. EVAT işlemi öncesi anevrizmanın anatomik özelliklerinin ayrıntılı değerlendirilmesinin işlemden en iyi oranda fayda görülmesi açısından önemlidir.

Keywords

• Endovasküler aort tamiri,endovasküler anevrizma onarımı,abdominal aort anevrizması,mortalite,morbidite,EVAT

Factors Affecting Mortality and Morbidity After Endovascular Aortic Repair for Abdominal Aortic Aneurysms

Abstract

Objective: Endovascular aortic repair (EVAR) has been preferred increasingly surgical repair for abdominal aortic aneurysms (AAAs). This minimally invasive procedure has favorable effects in the early period but our purpose is to reveal the anatomical and non-anatomical risk factors affecting mortality and morbidity after EVAR in the prolonged period.

Materials and Methods: A total of 96 patients ( 91m, 5 f) electively EVAR operated for infrarenal AAAs between September 2014 to January 2019 is included to the study. Preoperative and postoperative computed tomography (CT) scans is controlled periodly and determined individually. Demographic factors, anatomical properties of the AAAs and non-anatomical risk factors are assessed. Kaplan-Meier survival analysis was used to determine survival rates. Cox regression and hazard ratio (HR) was used to assess the relation of these determined factors on mortality and morbidity.

Results: Mean follow up time was 27,45 ± 12,99 months. We found that aortic neck morphology has an statistically significant effect on mortality (p value: 0.046 and HR: 1,73 [ 1,01-2,96]). Aortic neck angle, cigarette smoking, obesity, Peripheral artery disease(PAD), coronary artery disease, chronic obstructive pulmonary disease have an increased hazard ratio on mortality ( HR in order; 1,39; 1,45; 3,33; 1,84; 1,87; 3,60). Increased creatinine level (p value: 0.003), precence of chronic renal failure (p value: 0.013)and diabetes mellitus (p value: 0.038) have an statistically significant negative effect on morbidity. Obesity and PAD have an increased hazard ratio on morbidity(HR in order; 4,58; 1,61).

Conclusion: This study showed us survival after EVAR procedure is connected with several pre and postoperative factors. Preoperative datailed evaluation for the anatomical properties of aneurysm is important to achieve prolonged benefit and postoperative follow up is crucial.

Keywords

• Endovascular aortic repair,endovascular aneurysm repair,abdominal aortic aneurysm,EVAR,mortality,morbidity

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