腹主动脉瘤腔内修复术后Ⅱ型内漏的影响因素分析  

Analysis of influencing factors of type II endoleak after endovacular repair of abdominal aortic aneurysm

作　　者：张智涛 李延俊 孙岩 Zhang Zhitao;Li Yanjun;Sun Yan(Department of Radiology,Binzhou Second People's Hospital,Binzhou 256800,Shandong,China;Department of Vascular Surgery,Provincial Hospital Affiliated to Shandong First Medical University,Ji'nan 250021,Shandong,China)

机构地区：[1]滨州市第二人民医院医学影像科,山东滨州256800 [2]山东第一医科大学附属省立医院血管外科,山东济南250021

出　　处：《血管与腔内血管外科杂志》2024年第6期681-685,705,共6页Journal of Vascular and Endovascular Surgery

基　　金：山东省中医药科技发展计划(2019-0303);山东省医药卫生科技发展计划(2018WS273)。

摘　　要：目的探讨腹主动脉瘤(AAA)瘤腔内血栓形态与腹主动脉瘤腔内修复术(EVAR)后发生Ⅱ型内漏的关系。方法收集2018年1月至2022年6月于滨州市第二人民医院和山东第一医科大学附属省立医院接受EVAR治疗的182例AAA患者的临床资料和影像学资料,根据随访期内是否发生Ⅱ型内漏将患者分为Ⅱ型内漏组(n=44)和对照组(n=138)。比较两组患者的临床特征、血液指标、计算机断层扫描血管成像(CTA)影像学特征,筛选EVAR术后发生Ⅱ型内漏的影响因素,建立预测模型并绘制列线图,并通过绘制模型的校准曲线、受试者工作特征(ROC)曲线和临床决策曲线验证预测模型的准确性。结果两组患者的高血压病史、吸烟史、最大横截面血栓厚度、最大横截面血栓面积、血栓体积、最大瘤体直径和腰动脉数量比较,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,最大横截面血栓厚度厚、最大横截面血栓面积大、血栓体积大均是EVAR术后发生Ⅱ型内漏的保护因素,腰动脉数量多是EVAR术后发生Ⅱ型内漏的危险因素(P﹤0.05)。模型的ROC曲线下面积为0.901。校准曲线显示模型预测曲线与预期曲线重合性较好。临床决策曲线显示,若截断值为4%~98%,则模型的临床有效性较好。结论最大横截面血栓厚度、最大横截面血栓面积、血栓体积和腰动脉数量均是EVAR术后发生Ⅱ型内漏的影响因素,据此构建的预测模型准确性较高,可用于预测EVAR术后Ⅱ型内漏的发生风险。Objective To investigate the correlation study between the morphology of intraluminal thrombus in the abdominal aortic aneurysm(AAA)and type II endoleak after endovascular aneurysm repair(EVAR).Method The clinical data and imaging data(computed tomography angiography imaging data)of 182 AAA patients who received EVAR treatment at Binzhou Second People's Hospital and Provincial Hospital Affiliated to Shandong First Medical University from January 2018 to June 2022 were collected.According to whether type II endoleak occurred during the follow-up period,the patients were divided into type II endoleak group(n=44)and control group(n=138).The clinical characteristics,blood indicators,and computed tomography angiography(CTA)imaging characteristics of two groups of patients were compared,the influencing factors of type II internal endoleak after EVAR surgery was screened,the prediction model was established and draw nomogram was drawn,and the accuracy of the predictive model was verified by drawing the calibration curve,receiver operating characteristic(ROC)curve,and clinical decision curve of the model.Result The differences in hypertension history,smoking history,maximum cross-sectional thrombus thickness,maximum cross-sectional thrombus area,thrombus volume,maximum tumor diameter,and number of lumbar arteries between the two groups of patients were statistically significant(P<0.05).The results of multiple factor analysis showed that thick maximum cross-sectional thrombus thickness,large maximum cross-sectional thrombus area,and large thrombus volume were all protective factors for type II internal endoleak after EVAR surgery,while the large number of lumbar arteries was a risk factor for type II internal endoleak after EVAR surgery(P<0.05).The area under the ROC curve of the model is 0.901.The calibration curve shows that the predicted curve of the model overlaps well with the expected curve.The clinical decision curve shows that if the cutoff value was between 4%and 98%,the clinical effectiveness of the model was go

关 键 词：腹主动脉瘤 腹主动脉瘤腔内修复术 Ⅱ型内漏 计算机断层扫描血管成像 预测模型 

分 类 号：R543[医药卫生—心血管疾病]