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高危患者血管内动脉瘤修复术的引入对我们治疗肾下腹主动脉瘤的择期治疗实践的影响。

Impact of the introduction of endovascular aneurysm repair in high-risk patients on our practice of elective treatment of infrarenal abdominal aortic aneurysms.

作者信息

Alsac Jean-Marc, Houbballah Rabih, Francis Fady, Paraskevas Nikolaos, Coppin Thierry, Cerceau Olivier, Castier Yves, Leseche Guy

机构信息

Service de Chirurgie Vasculaire, Thoracique et Transplantation Pulmonaire, Bichat-Claude Bernard University Hospital, Paris, France.

出版信息

Ann Vasc Surg. 2008 Nov;22(6):829-33. doi: 10.1016/j.avsg.2008.03.007. Epub 2008 Sep 19.

Abstract

The aim of this work was to evaluate, in terms of activity and immediate postoperative results, the modifications of our elective surgical treatment of infrarenal abdominal aortic aneurysms (AAAs) resulting from the use of stent grafts to treat AAAs, following the recommendations issued by the French Health Products Safety Agency (AFSSAPS) in December 2003. This monocentric and retrospective study used the clinical data of patients operated on for asymptomatic AAA between January 2001 and December 2006. Endovascular treatment of AAAs with aortic stent grafts was introduced in our current practice in January 2004, following the recommendations of the AFSSAPS (high-risk patients for open surgery presenting with an AAA > or =50 mm). Group I was composed of patients operated on between January 2001 and December 2003 according to the standard open technique. Group II was composed of patients operated on between January 2004 and December 2006 with either standard open surgery or endovascular surgery. The main criteria of evaluation were the number of operated patients, their American Society of Anesthesiology (ASA) score of surgical risk, and the intrahospital morbidity and mortality. The number of treated patients significantly increased between these two periods (group I n = 49, group II n = 88, with 38 endovascular treatments; p < 0.001), without any changes in average age (70 vs. 72 years), percentage of men (93.7% vs. 95.5%), and mean AAA size (57.8 vs. 56 mm) between the two groups. ASA scores were significantly higher in group II (ASA III and IV, group I = 20.4% vs. group II = 55.7%; p < 0.0001), whereas the intrahospital mortality rate (4.1% vs. 3.4%) and the rate of major postoperative complications (16.3% vs. 11%) have remained stable. In group II, the median duration of hospitalization was significantly reduced (12 vs. 9 days, p < 0.001). In conclusion, in our center, following the AFSSAPS recommendations, the introduction of endovascular treatment has enabled us to electively treat a greater number of AAA patients with higher surgical risk, without aggravating the immediate postoperative results.

摘要

本研究旨在根据法国卫生产品安全局(AFSSAPS)2003年12月发布的建议,从活动情况和术后即刻结果方面评估使用支架移植物治疗腹主动脉瘤(AAA)对我们选择性手术治疗肾下腹主动脉瘤的改变。这项单中心回顾性研究使用了2001年1月至2006年12月期间接受无症状AAA手术患者的临床数据。根据AFSSAPS的建议(开放手术高危患者,AAA直径≥50mm),2004年1月我们开始在当前实践中采用主动脉支架移植物对AAA进行血管内治疗。第一组由2001年1月至2003年12月期间按照标准开放技术进行手术的患者组成。第二组由2004年1月至2006年12月期间接受标准开放手术或血管内手术的患者组成。评估的主要标准是手术患者数量、美国麻醉医师协会(ASA)手术风险评分以及院内发病率和死亡率。这两个时期治疗的患者数量显著增加(第一组n = 49,第二组n = 88,其中38例为血管内治疗;p < 0.001),两组之间的平均年龄(70岁对72岁)、男性百分比(93.7%对95.5%)和平均AAA大小(57.8mm对56mm)没有任何变化。第二组的ASA评分显著更高(ASA III和IV,第一组 = 20.4%对第二组 = 55.7%;p < 0.0001),而院内死亡率(4.1%对3.4%)和术后主要并发症发生率(16.3%对11%)保持稳定。在第二组中,住院时间中位数显著缩短(12天对9天,p < 0.001)。总之,在我们中心,遵循AFSSAPS的建议,血管内治疗的引入使我们能够选择性地治疗更多手术风险更高的AAA患者,而不会加重术后即刻结果。

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