腹主动脉瘤手术适应证及形态学破裂风险评估的进展

Advances in surgical indications and morphological rupture-risk assessment of abdominal aortic aneurysms

目的总结腹主动脉瘤(abdominal aortic aneurysm,AAA)的干预阈值的最新循证医学证据以及AAA形态学破裂风险评估方面的新进展及其临床应用价值。方法收集关于特定人群的AAA患者以及特殊形态学特征AAA的破裂风险的国内外文献并进行综述。结果进一步降低干预阈值后,特定亚组的无症状患者同样可能从AAA手术中获益。同时,除了瘤体最大径外,瘤体真实几何形态、瘤壁厚度、附壁血栓等形态学因素对于AAA的破裂风险同样有着重要的预测价值。结论制定基于AAA患者实际情况的个体化破裂风险评估方案,能更准确地服务于临床的诊断和治疗。

Objective This paper aimed to summarize the new progress in surgical indications regarding as maximum diameter from evidence-based medical evidence and morphological rupture-risk assessment of abdominal aortic aneurysms (AAA) and its clinical application value. Method The rupture-risk and its mechanism of AAA in specific population and morphological characteristics were reviewed. Results Asymptomatic patients in specific subgroups may also benefit from AAA repair by lowering the intervention threshold. Besides the maximum diameter of aneurysm, other morphological factors, such as the true geometric shape, the wall thickness, and mural thrombus also had important predictive value for AAA rupture risk. Conclusion Rupture-risk assessment based on the actual individual situation of AAA patients can further facilitate the clinical diagnosis and treatment.