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

Year 2020, Volume: 10 Issue: 1, 65 - 73, 16.03.2020

Hakan Saçlı İbrahim Kara

https://doi.org/10.31832/smj.645571

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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