腹主动脉瘤破裂患者的血管内修复与开放手术：1年随访的临床结果

Endovascular repair versus open surgery in patients with ruptured abdominal aortic aneurysms: clinical outcomes with 1-year follow-up.

作者信息

Visser Jacob J, Bosch Johanna L, Hunink M G Myriam, van Dijk Lukas C, Hendriks Johanna M, Poldermans Don, van Sambeek Marc R H M

机构信息

Department of Epidemiology and Biostatistics, Erasmus MC, Rotterdam, The Netherlands.

出版信息

J Vasc Surg. 2006 Dec;44(6):1148-55. doi: 10.1016/j.jvs.2006.08.018.

DOI:10.1016/j.jvs.2006.08.018

PMID:17145414

Abstract

OBJECTIVE

To compare the clinical outcomes of treatment after endovascular repair and open surgery in patients with ruptured infrarenal abdominal aortic aneurysms (AAAs), including 1-year follow-up.

METHODS

All consecutive conscious patients with ruptured infrarenal AAAs who presented to our tertiary care teaching hospital between January 1, 2001, and December 31, 2005, were included in this study (n = 55). Twenty-six patients underwent endovascular repair, and 29 patients underwent open surgery. Patients who were hemodynamically too unstable to undergo a computed tomography angiography scan were excluded. Outcomes evaluated were intraoperative mortality, 30-day mortality, systemic complications, complications necessitating surgical intervention, and mortality and complications during 1-year follow-up. The statistical tests we used were the Student t test, chi2 test, Fisher exact test, and Mann-Whitney U test (two sided; alpha = .05).

RESULTS

Thirty-day mortality was 8 (31%) of 26 patients who underwent endovascular repair and 9 (31%) of 29 patients who underwent open surgery (P = .98). Systemic complications and complications necessitating surgical intervention during the initial hospital stay were similar in both treatment groups (8/26 [31%] and 5/26 [19%] for endovascular repair, respectively, and 9/29 [31%] and 8/29 [28%] for open surgery, respectively; P > .40). During 1-year follow-up, two patients initially treated with endovascular repair died as a result of non-aneurysm-related causes; no death occurred in the open surgery group. Complications during 1-year follow-up were 1 (5%) of 20 for endovascular repair and 4 (16%) of 25 for open surgery (P = .36).

CONCLUSIONS

On the basis of our study with a highly selected population, the mortality and complication rates after endovascular repair may be similar compared with those after open surgery in patients treated for ruptured infrarenal AAAs.

摘要

目的

比较破裂性肾下腹主动脉瘤（AAA）患者血管腔内修复术和开放手术后的临床结局，包括1年随访。

方法

纳入2001年1月1日至2005年12月31日期间在我们的三级医疗教学医院就诊的所有连续性清醒的破裂性肾下AAA患者（n = 55）。26例患者接受了血管腔内修复术，29例患者接受了开放手术。血流动力学极不稳定无法进行计算机断层血管造影扫描的患者被排除。评估的结局包括术中死亡率、30天死亡率、全身并发症、需要手术干预的并发症以及1年随访期间的死亡率和并发症。我们使用的统计检验方法有Student t检验、chi2检验、Fisher精确检验和Mann-Whitney U检验（双侧；α = 0.05）。

结果

接受血管腔内修复术的26例患者中有8例（31%）30天死亡率，接受开放手术的29例患者中有9例（31%）30天死亡率（P = 0.98）。两个治疗组在初次住院期间的全身并发症和需要手术干预的并发症相似（血管腔内修复术分别为8/26 [31%]和5/26 [19%]，开放手术分别为9/29 [31%]和8/29 [28%]；P > 0.40）。在1年随访期间，最初接受血管腔内修复术治疗的两名患者因非动脉瘤相关原因死亡；开放手术组无死亡病例。血管腔内修复术1年随访期间的并发症为20例中的1例（5%），开放手术为25例中的4例（16%）（P = 0.36）。