Brandt Michael, Walluscheck Knut P, Jahnke Thomas, Graw Karoline, Cremer Jochen, Müller-Hülsbeck Stefan
The Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, 24105 Kiel, Germany.
J Vasc Interv Radiol. 2005 Oct;16(10):1309-12. doi: 10.1097/01.RVI.0000175332.44635.49.
Open repair of ruptured abdominal aortic aneurysms (AAAs) still has a high associated mortality rate. The impact of the introduction of endovascular treatment on the early outcomes of ruptured AAAs was examined at a single institution. The suitability of acute endovascular aneurysm repair (EVAR) in patients with ruptured AAAs was also assessed.
Retrospective review was conducted in 39 consecutive patients treated for ruptured AAA from 2001 to 2004. The patients were divided into 15 who underwent open repair from 2001 to 2002 (group I) and 24 who were treated with open repair (n=13; 54%) or endovascular repair (n=11; 46%) from 2003 to 2004 (group II). Hospital charts and computed tomographic scans were reviewed to evaluate the feasibility of EVAR.
Age, sex, and aneurysm size were similar between the two groups. The 30-day mortality rates were 53% in group I and 8% in group II (P=.003). Median procedure times were shorter in the patients who underwent EVAR. Intensive care unit stay and hospital stay were 22.0 days+/-29.6 and 29.7 days+/-33.8, respectively, in group I, and 5.6 days+/-4.4 and 16.1 days+/-10.9, respectively, in group II (P<<.03). Eleven patients were found ineligible for EVAR as a result of an unsuitable neck (n=5) or iliac arteries (n=3) or both (n=3). No graft failure was detected during follow-up.
After introduction of acute EVAR, a total of 46% of patients with ruptured AAAs were treated with the procedure. Potentially, 54% of patients could have been suitable for EVAR. Endovascular stent-graft implantation has significantly improved outcomes in ruptured AAAs and may therefore be beneficial in the overall treatment strategy in these patients.
腹主动脉瘤破裂的开放修复手术死亡率仍然很高。在一家机构中研究了血管内治疗的引入对破裂腹主动脉瘤早期结果的影响。还评估了急性血管内动脉瘤修复术（EVAR）在腹主动脉瘤破裂患者中的适用性。
对2001年至2004年连续治疗的39例腹主动脉瘤破裂患者进行回顾性研究。患者分为两组，2001年至2002年接受开放修复的15例（第一组），2003年至2004年接受开放修复（n = 13；54%）或血管内修复（n = 11；46%）的24例（第二组）。查阅医院病历和计算机断层扫描以评估EVAR的可行性。
两组患者的年龄、性别和动脉瘤大小相似。第一组30天死亡率为53%，第二组为8%（P = 0.003）。接受EVAR的患者中位手术时间较短。第一组重症监护病房停留时间和住院时间分别为22.0天±29.6天和29.7天±33.8天，第二组分别为5.6天±4.4天和16.1天±10.9天（P << 0.03）。11例患者因颈部（n = 5）或髂动脉（n = 3）或两者（n = 3）不合适而被认为不适合进行EVAR。随访期间未检测到移植物失败。
引入急性EVAR后，共有46%的腹主动脉瘤破裂患者接受了该手术。潜在地，54%的患者可能适合EVAR。血管内支架移植物植入显著改善了破裂腹主动脉瘤的治疗结果，因此可能对这些患者的整体治疗策略有益。
