Arko F R, Lee W A, Hill B B, Olcott C, Harris E J, Dalman R L, Fogarty T J, Zarins C K
Division of Vascular Surgery, Stanford University School of Medicine, CA 94305-5642, USA.
J Vasc Surg. 2001 Nov;34(5):885-91. doi: 10.1067/mva.2001.118816.
The purpose of this study was to determine the impact of an endovascular stent-graft program on vascular training in open aortic aneurysm surgery.
The institutional and vascular surgery fellow experience in aortic aneurysm repair during a 6-year period was reviewed. The 3-year period before introduction of endovascular repair was compared with the 3-year period after introduction of endovascular repair. All patients undergoing abdominal aortic aneurysm (AAA) or thoracoabdominal aortic aneurysm repairs were entered prospectively into a vascular registry and retrospectively analyzed to evaluate the changing patterns in aortic aneurysm treatment and surgical training.
Between July 1994 and June 2000, a total of 588 patients with AAA or thoracoabdominal aneurysms were treated at Stanford University Medical Center. There were 296 (50%) open infrarenal AAA repairs, 87 (15%) suprarenal AAA repairs, 47 (8%) thoracoabdominal aneurysm repairs, and 153 (26%) endovascular stent-grafts. The total number of aneurysms repaired per year by vascular fellows before the endovascular program was 71.3 +/- 4.9 (range, 68-77) and increased to 124.7 +/- 35.6 (range, 91-162) after introduction of endovascular repair (P <.05). This increase was primarily caused by the addition of endovascular stent-graft repairs by vascular fellows (51.0 +/- 29.0/year [range, 23-81]). There was no change in the number of open infrarenal aortic aneurysm repairs per year, 53.0 +/- 6.6 (range, 48-56) before endovascular repair versus 47.0 +/- 1.7 (range, 46-49) after (P = not significant). There was a significant increase in the number of suprarenal AAA repairs per year by vascular fellows, 10.0 +/- 1.0 (range, 9-11) before endovascular repair compared with 19.0 +/- 6.5 (range, 13-26) after (P <.05). There was no change in the number of thoracoabdominal aneurysm repairs per year between the two groups, 8.0 +/- 3.0 (range, 4-11) before endovascular repair compared with 7.6 +/- 2.3 (range, 5-9) after.
Introduction of an endovascular aneurysm stent-graft program significantly increased the total number of aneurysms treated. Although the number of open aneurysm repairs has remained the same, the complexity of the open aneurysm experience has increased significantly for vascular fellows in training.
本研究的目的是确定血管内支架移植物项目对开放性主动脉瘤手术中血管训练的影响。
回顾了6年期间机构和血管外科住院医师在主动脉瘤修复方面的经验。将血管内修复引入前的3年与引入后的3年进行比较。所有接受腹主动脉瘤（AAA）或胸腹主动脉瘤修复的患者均前瞻性地纳入血管登记册，并进行回顾性分析，以评估主动脉瘤治疗和手术训练的变化模式。
1994年7月至2000年6月，斯坦福大学医学中心共治疗了588例AAA或胸腹主动脉瘤患者。其中296例（50%）为开放性肾下AAA修复，87例（15%）为肾上AAA修复，47例（8%）为胸腹主动脉瘤修复，153例（26%）为血管内支架移植物修复。在血管内项目开展前，血管外科住院医师每年修复的动脉瘤总数为71.3±4.9（范围68 - 77），在引入血管内修复后增加到124.7±35.6（范围91 - 162）（P <.05）。这种增加主要是由于血管外科住院医师增加了血管内支架移植物修复（51.0±29.0/年[范围23 - 81]）。每年开放性肾下主动脉瘤修复的数量没有变化，血管内修复前为53.0±6.6（范围48 - 56），之后为47.0±1.7（范围46 - 49）（P = 无显著性差异）。血管外科住院医师每年进行的肾上AAA修复数量显著增加，血管内修复前为10.0±1.0（范围9 - 11），之后为19.0±6.5（范围13 - 26）（P <.05）。两组之间每年胸腹主动脉瘤修复的数量没有变化，血管内修复前为8.0±3.0（范围4 - 11），之后为7.6±2.3（范围5 - 9）。
血管内动脉瘤支架移植物项目的引入显著增加了治疗的动脉瘤总数。尽管开放性动脉瘤修复的数量保持不变，但对于接受培训的血管外科住院医师来说，开放性动脉瘤手术经验的复杂性显著增加。
