Morasch Mark D, Kibbe Melina R, Evans Mary E, Meadows Wendy S, Eskandari Mark K, Matsumura Jon S, Pearce William H
Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
J Vasc Surg. 2004 Jul;40(1):12-6. doi: 10.1016/j.jvs.2004.03.019.
Percutaneous treatment of an abdominal aortic aneurysm (AAA) is feasible, but is associated with a unique set of risks. A comparison of Excluder endograft deployment with femoral artery cutdown (FAC) versus percutaneous femoral access (PFA) for treatment of infrarenal AAA was undertaken.
A single-institution, controlled, retrospective review was carried out in patients who underwent either bilateral FAC or bilateral PFA for endovascular repair of infrarenal AAA with the Gore bifurcated Excluder endograft between March 1999 and November 2003. To November 2000, 35 patients underwent bilateral FAC; since then, 47 patients have undergone bilateral PFA. All have been followed up for at least 30 days.
Mean AAA size was 5.7 cm in the FAC group and 6.0 cm in the PFA group. During hospitalization there were six access-related complications in the FAC group; three required early surgical intervention. In the PFA group nine perioperative access-related complications occurred, all consisting of either hemorrhage or arterial occlusion; seven required additional intervention, and were recognized and ameliorated while the patient was still in the operating room. At 30-day follow-up there were no additional access-related complications in the PFA group. There were eight other access-related complications in eight additional patients who underwent FAC. In patients undergoing bilateral PFA total operative time was shorter (PFA 139 minutes vs FAC 169 minutes; P =.002), total in-room anesthesia time was less (PFA 201 minutes vs FAC 225 minutes; P <.008), and use of general anesthesia was reduced (P <.001). No significant differences were observed between groups with respect to estimated blood loss (PFA 459 mL vs FAC 389 mL; P =.851).
Complete percutaneous treatment of AAA may have some advantages over open femoral artery access, but it is not free from risk. Percutaneous treatment of AAA can be completed successfully in most patients, but should be performed at an institution where conversion to an open procedure can be completed expeditiously if necessary.
经皮治疗腹主动脉瘤（AAA）是可行的，但伴有一系列独特的风险。本研究对用于治疗肾下腹主动脉瘤的Excluder血管内支架移植物经股动脉切开（FAC）置入与经皮股动脉穿刺（PFA）置入进行了比较。
对1999年3月至2003年11月期间采用Gore分叉Excluder血管内支架移植物对肾下腹主动脉瘤进行血管内修复且接受双侧FAC或双侧PFA的患者进行了单机构、对照、回顾性研究。至2000年11月，35例患者接受了双侧FAC；此后，47例患者接受了双侧PFA。所有患者均随访至少30天。
FAC组腹主动脉瘤平均大小为5.7 cm，PFA组为6.0 cm。住院期间，FAC组发生6例与穿刺通道相关的并发症；3例需要早期手术干预。PFA组发生9例围手术期与穿刺通道相关的并发症，均为出血或动脉闭塞；7例需要额外干预，且在患者仍在手术室时即被发现并得到改善。在30天随访时，PFA组未出现其他与穿刺通道相关的并发症。另外8例接受FAC的患者出现了8例其他与穿刺通道相关的并发症。接受双侧PFA的患者总手术时间较短（PFA为139分钟，FAC为169分钟；P = 0.002），总室内麻醉时间较少（PFA为201分钟，FAC为225分钟；P < 0.008），全身麻醉的使用减少（P < 0.001）。两组间估计失血量无显著差异（PFA为459 mL，FAC为389 mL；P = 0.851）。
腹主动脉瘤的完全经皮治疗可能比开放股动脉穿刺有一些优势，但并非没有风险。大多数患者可以成功完成腹主动脉瘤的经皮治疗，但应在必要时能够迅速转为开放手术的机构进行。
