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目的:探讨肾下型腹主动脉瘤行血管腔内修复术（EVAR）后长期口服阿司匹林对瘤囊扩张情况及持续性Ⅱ型内漏的影响。方法:本研究为回顾性队列研究。回顾性分析2019年1月至 2021年12月在南京大学医学院附属鼓楼医院血管外科接受EVAR治疗的133例肾下型腹主动脉瘤患者的临床资料。其中男性113例，女性20例，年龄（74.8±7.2）岁（范围：59~95岁）。根据患者术后是否长期规律服用阿司匹林，将其分为服用阿司匹林组（ n=80）与未服用阿司匹林组（ n=53）。采用倾向性评分匹配的方法对两组患者进行1∶1匹配，卡钳值为0.05。采用Kaplan-Meier法绘制两组患者主要终点事件（瘤囊扩大、发生持续性Ⅱ型内漏）和次要终点事件（不良心脑血管事件和临床相关出血事件）发生的累积概率曲线，并用Log-Rank 法进行比较。 结果:倾向性评分匹配后，两组均纳入32例患者。两组患者结局事件的累积概率曲线比较结果显示，服用阿司匹林组患者的瘤囊扩大率（Log-Rank检验： P=0.010）、持续性Ⅱ型内漏发生率（Log-Rank检验： P=0.019）均高于未接受阿司匹林组，差异有统计学意义。两组不良心血管事件和临床相关出血事件发生率的差异均无统计学意义（Log-Rank检验： P值均>0.05）。 结论:血管腔内修复术后长期服用阿司匹林患者的瘤囊扩张率和持续性Ⅱ型内漏发生率高于未服用阿司匹林组，应在术前对该类患者的手术风险和获益进行全方面评估。

Objective:To investigate the effect of long-term oral aspirin on the changes in the aneurysm sac and persistent type Ⅱ endoleak after endovascular aortic repair (EVAR) of infrarenal abdominal aortic aneurysms based on propensity score-matched analysis.Methods:A retrospective cohort study was used to analyze the clinical data of 133 patients with infrarenal abdominal aortic aneurysms treated with EVAR from January 2019 to December 2021 in the Department of Vascular Surgery, Nanjing Drum Tower Hospital. There were 113 males and 20 females, aged (74.8±7.2) years (range: 59 to 95 years). Patients were divided into the group receiving aspirin ( n=80) and the group not taking aspirin ( n=53) based on whether they took aspirin regularly for a long time after surgery. The two groups were matched in a 1∶1 ratio using propensity score matching and the caliper value was 0.05. Cumulative probability curve was plotted using the Kaplan-Meier method and the Log-rank test was used to compare the differences in primary endpoint events (enlargement of the aneurysm sac, occurrence of persistent type Ⅱ endoleak) and secondary endpoint events (adverse cardiovascular events and clinically relevant bleeding events) between the two groups. Results:A matched cohort was established after propensity score matching, resulting in 32 cases per group. The survival analysis found that the rate of aneurysm sac enlargement was significantly higher in the group receiving aspirin than in the group not taking aspirin ( P=0.010), and the incidence of persistent type Ⅱ endoleak was significantly higher than that in the group not taking aspirin ( P=0.019). The incidence of adverse cardiovascular events and clinically relevant bleeding events were not significantly different in two groups ( P=0.061, P=0.286). Conclusions:The risk of aneurysm sac expansion and persistent type Ⅱ endoleak were significantly higher in patients taking long-term aspirin after EVAR than in the group not taking asprin. Therefore, high-risk abdominal aortic aneurysm (AAA) patients who are prone to aneurysm sac expansion should be evaluated in advance so that the risks and benefits of surgery can be comprehensively evaluated and treatment strategies can be optimized.