腔内血栓与主动脉壁减弱在小型破裂性腹主动脉瘤中相关

Intraluminal Thrombus Is Associated With Aortic Wall Weakening in Small Ruptured Abdominal Aortic Aneurysms

Objective: It has long been known that hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) broadly reduce cardiovascular events in patients with peripheral vascular disease. It was the goal of this study to determine if statin therapy significantly improves primary patency rates after stenting of superficial femoral and popliteal arteries.

Methods: The records of all patients undergoing primary nitinol stenting of the femoral and popliteal arteries at a single institution and by a single surgeon during a 7-year period were reviewed. Patient demographics and risk factors were identified. TransAtlantic Inter-Society Consensus (TASC II) classifications were determined for all stented lesions to stratify severity of disease. Analysis was performed to determine whether the use of statins at the time of stent placement influenced patency. Loss of primary patency was said to have occurred when an intrastent occlusion or a 50% or greater stenosis was identified by arterial duplex ultrasound or angiography. Kaplan-Meier survival curves were plotted, and differences between groups were tested by log-rank method.

Results: Between 2007 and 2014, primary femoral or popliteal stenting was performed on 162 limbs in 141 patients. At the time of intervention, 55.5% of these patients were being treated with statin therapy. There were 88 interventions performed for claudication and 74 for critical limb ischemia; 107 lesions treated were TASC A or B, and 55 were TASC C or D. Primary patency rates for all stented lesions was 68%, 53%, and 43% at 12, 24, and 36 months. Those taking statins had patency rates of 75%, 58%, and 47%, whereas the patency rates for those not taking statins were 55%, 45%, and 36% at 12, 24, and 36 months, respectively (P ¼ .179). Statins had no significant influence on patency rates when lesions were stratified for severity (TASC A/B, P ¼ .162; C/D, P ¼ .638). There was no significant difference in those treated for claudication or critical limb ischemia (P ¼ .929). Statin compliance was found to be 86% at a mean follow-up of 23.6 months.

Conclusions: Whereas the use of statins has been shown to reduce cardiovascular morbidity and mortality in patients with peripheral vascular disease, the ability of these drugs to improve primary patency rates of patients after superficial femoral and popliteal artery stenting remains speculative.

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