Oversizing Consideration of Proximal Stent Graft in Hemodynamically Stable and Unstable Patients Undergoing Emergent Endovascular Aortic Repair
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Approvals
2.2. Participants
2.3. Exposures
2.4. Outcomes of Interest and Follow-Up Protocols
2.5. Variables
2.6. Statistical Analyses
3. Results
3.1. Baseline Characteristics
3.2. Risk Factors of T1AEL in Emergent EVAR
3.3. Comparison of Outcomes in Hemodynamically Unstable and Stable Patients
3.4. OSR > 30% versus OSR ≤ 30% in Hemodynamically Unstable Patients
3.5. OSR > 20% versus OSR ≤ 20% in Hemodynamically Stable Patients
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Hemodynamically Stable | Hemodynamically Unstable | p-Value | |
---|---|---|---|
n = 90 | n = 44 | ||
Age -y | 70.41 ± 9.89 | 72.55 ± 8.24 | 0.22 |
MAP -mmHg | 97.91 ± 12.55 | 80.61 ± 9.30 | <0.001 |
HR -beats/min | 77.44 ± 13.08 | 103.82 ± 5.96 | <0.001 |
BMI -kg/m2 | 23.00 ± 3.15 | 22.93 ± 2.96 | 0.91 |
Neck diameter -mm | 20.39 ± 2.41 | 20.43 ± 2.45 | 0.93 |
OSR -% | 22% (20–27%) | 25% (22–32%) | 0.011 |
α angle -° | 27.66 (12.93–45.42) | 32.50 (10.77–66.73) | 0.025 |
β angle -° | 48.00 (32.00–76.00) | 57.23 (31.41–78.63) | 0.86 |
Neck length -mm | 27.83 ± 12.97 | 25.10 ± 10.02 | 0.22 |
Neck calcification | 0.01 (0.00–0.20) | 0.01 (0.00–0.20) | 0.76 |
Maximum diameter -mm | 57.81 ± 14.18 | 63.82 ± 19.26 | 0.048 |
Within IFU | 37 (41.11%) | 21 (47.73%) | 0.46 |
Gender | 0.027 | ||
Male | 73 (81.11%) | 28 (63.64%) | |
Female | 17 (18.89%) | 16 (36.36%) | |
Hypertension | 59 (65.56%) | 31 (70.45%) | 0.57 |
Diabetes | 10 (11.11%) | 7 (15.91%) | 0.43 |
Pulmonary diseases | 16 (17.78%) | 11 (25.00%) | 0.33 |
Peripheral artery disease | 6 (6.67%) | 3 (6.82%) | 0.97 |
Stroke | 6 (6.67%) | 0 (0.00%) | 0.97 |
PCI | 11 (12.22%) | 4 (9.09%) | 0.59 |
CKD | 8 (8.89%) | 9 (20.45%) | 0.059 |
CCI scores | 0.41 | ||
Mild (≤2) | 70 (77.78%) | 29 (65.91%) | |
Moderate (3–4) | 17 (18.89%) | 10 (22.73%) | |
Severe (≥5) | 3 (3.33%) | 5 (11.36%) | |
Anesthesia | 0.032 | ||
Local | 71 (78.89%) | 27 (61.36%) | |
General | 19 (21.11%) | 17 (38.64%) | |
Severe neck angulation | 24 (26.67%) | 18 (40.91%) | 0.10 |
CIAA | 29 (25.66%) | 9 (19.57%) | 0.41 |
Univariate Analysis | Multivariate Analysis * | |||
---|---|---|---|---|
Statistics | HR (95%CI) | p-Value | HR (95%CI) | p-Value |
Gender | 2.76 (0.61, 12.40) | 0.19 | ||
Age | 1.03 (0.94, 1.13) | 0.53 | ||
HD unstable | 1.87 (0.42, 8.45) | 0.41 | ||
MAP | 0.97 (0.91, 1.04) | 0.39 | ||
HR | 1.01 (0.96, 1.06) | 0.78 | ||
Anesthesia | 0.46 (0.05, 3.83) | 0.47 | ||
α angle | 0.99 (0.97, 1.01) | 0.42 | ||
β angle | 1.01 (0.99, 1.03) | 0.32 | ||
SNA | 2.24 (0.43, 11.67) | 0.34 | ||
Neck diameter | 1.27 (1.03, 1.56) | 0.028 | 0.92 (0.63, 1.35) | 0.67 |
OSR >30% vs. ≤30% | 0.57 (0.06, 5.07) | 0.62 | ||
OSR >20% vs. ≤20% | 0.06 (0.01, 0.31) | 0.001 | 0.06 (0.01, 0.72) | 0.026 |
Neck length | 0.83 (0.72, 0.95) | 0.009 | 0.74 (0.56, 0.98) | 0.033 |
Maximum diameter | 1.03 (0.98, 1.09) | 0.24 | ||
CIAA | 0.63 (0.13, 3.18) | 0.58 |
Hemodynamically Unstable | Hemodynamically Stable | |||||
---|---|---|---|---|---|---|
OSR | ≤30% (n = 30) | >30% (n = 14) | p | ≤20% (n = 24) | >20% (n = 66) | p |
Survival FU time-m | 24.50 (16.00–49.25) | 25.00 (9.75–53.00) | 0.99 | 30.50 (15.00–60.50) | 33.50 (11.50–69.25) | 0.57 |
Imaging FU time-m | 10.00 (1.00–39.50) | 1.50 (1.25–32.50) | 0.87 | 16.50 (5.00–29.00) | 15.00 (5.25–34.50) | 0.71 |
30-day mortality | 4 (13.33%) | 0 (.00%) | 0.15 | 1 (4.17%) | 1 (1.52%) | 0.45 |
Overall survival | 11 (36.67%) | 6 (42.86%) | 0.69 | 7 (29.17%) | 15 (22.73%) | 0.53 |
Reintervention | 2 (6.67%) | 1 (7.14%) | 0.95 | 4 (16.67%) | 6 (9.09%) | 0.31 |
T1AEL | 3 (11.11%) | 0 (0.00%) | 0.19 | 4 (16.67%) | 1 (1.52%) | 0.006 |
T1BEL | 2 (7.41%) | 0 (0.00%) | 0.30 | 3 (12.50%) | 4 (6.06%) | 0.31 |
T2EL | 5 (18.52%) | 2 (14.29%) | 0.73 | 6 (25.00%) | 14 (21.21%) | 0.70 |
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Qi, Y.; Weng, C.; Yuan, D.; Wang, T.; Ma, Y.; Yang, Y.; Zhao, J.; Huang, B. Oversizing Consideration of Proximal Stent Graft in Hemodynamically Stable and Unstable Patients Undergoing Emergent Endovascular Aortic Repair. J. Clin. Med. 2023, 12, 7500. https://doi.org/10.3390/jcm12237500
Qi Y, Weng C, Yuan D, Wang T, Ma Y, Yang Y, Zhao J, Huang B. Oversizing Consideration of Proximal Stent Graft in Hemodynamically Stable and Unstable Patients Undergoing Emergent Endovascular Aortic Repair. Journal of Clinical Medicine. 2023; 12(23):7500. https://doi.org/10.3390/jcm12237500
Chicago/Turabian StyleQi, Yuhan, Chengxin Weng, Ding Yuan, Tiehao Wang, Yukui Ma, Yi Yang, Jichun Zhao, and Bin Huang. 2023. "Oversizing Consideration of Proximal Stent Graft in Hemodynamically Stable and Unstable Patients Undergoing Emergent Endovascular Aortic Repair" Journal of Clinical Medicine 12, no. 23: 7500. https://doi.org/10.3390/jcm12237500