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A New Murine Model of Endovascular Aortic Aneurysm Repair
Published on: July 7, 2013
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選択的な修復を拒むまたは不適格な患者における大きな腹部大動脈動脈瘤の破裂率
Frank A Lederle1, Gary R Johnson, Samuel E Wilson
1Department of Medicine, Veterans Affairs Medical Center, Minneapolis, Minn 55417, USA. frank.lederle@med.va.gov
JAMA
|June 8, 2002
まとめ
大量の腹部大動脈動脈瘤 (AAA) を有する高リスク患者は,かなりの破裂リスクに直面します. このリスクは,大きな動脈瘤直径,特に7.0cm以上で,著しく増加します.
科学分野:
- 血管外科 血管外科
- 大動脈動脈瘤の研究
- 患者リスクの階層化
背景:
- 腹動脈動脈瘤 (AAA) の修復は,高リスクの患者では,破裂が迫っているまで,しばしば延期されます.
- この集団における大きなAAAの破裂リスクに関するデータは限られている.
- 現在のガイドラインには,大型AAAの断裂リスクに関する正確なデータがない.
研究 の 目的:
- 大型の腹部大動脈動脈瘤 (AAA) の患者における破裂の発生率を決定する.
- AAA破裂リスクのデータを直径によって層分化して提供します.
- 高手術リスクのAAA患者に対する臨床的意思決定の情報提供.
主な方法:
- 47の退役軍人の医療センターで実施された前向きなコホート研究.
- 選択的な修理を予定している者を除く,少なくとも5.5cmのAAAを持つ,手術リスクの高い退役軍人198人を登録しました.
- 患者さんを平均1.52年間追跡し,AAA破裂の発生率を初期と到達直径によって評価した.
主要な成果:
- AAA破裂の可能性の1年間の発生率は,5.5-5.9cmの場合9.4%,6.0-6.9cmの場合10.2%,7.0cm以上AAAの場合32.5%でした.
- 直径8.0cmに達する動脈瘤は,6ヶ月以内に25.7%の破裂率を持っていた.
- 全体的な死亡率は57%で,検死を受けたのは46%でした.
結論:
- 高手術リスクの患者で,AAA ≥5.5cmの患者は,破裂のリスクが高い.
- AAA破裂の発生率は,動脈瘤の直径が増加するにつれて著しく上昇します.
- これらの発見は,大きなAAAを持つ高リスク患者への介入を慎重に検討する必要性を強調しています.
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