Hislop Sean J, Patel Siddharth A, Abt Peter L, Singh Michael J, Illig Karl A
Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.
Ann Vasc Surg. 2009 Mar;23(2):194-200. doi: 10.1016/j.avsg.2008.10.002. Epub 2008 Dec 6.
The purpose of this study was to evaluate changing trends in therapy and determinants of outcomes among patients with a renal artery aneurysm (RAA) undergoing surgical or endovascular repair in New York State (NYS). A retrospective cohort study of patients who underwent therapy for RAA in NYS from October 1, 2000, to December 31, 2006, was identified from the Statewide Planning and Research Cooperative System database. Regression models which included hospital and patient characteristics were created to identify predictors of untoward events following surgical or endovascular intervention. Over this time period 215 patients with RAA repairs were analyzed. In multivariate analysis, preoperative predictors of death included diabetes (adjusted odds ratio [OR]=57.8, 95% confidence interval [CI] 2.3-1,430.1, p=0.013), the presence of other aneurysms (adjusted OR=18.5, CI 1.5-234.4, p=0.024), and coagulopathy (adjusted OR=16.9, CI 3.4-393.1, p=0.03) but not repair type. Perioperative cardiac (adjusted OR=16.7, CI 1.4-197.1, p=0.026) and vascular device-related (adjusted OR=11.1, CI 1.003-123.0, p=0.049) complications were predictive of mortality. When patients with other aneurysms were excluded from analysis (n=153), there were no significant predictors of death. Ninety-one endovascular and 124 open surgical repairs were performed with a significant increase in the proportion of endovascular repairs performed over time (p<0.001), although since 2003 the proportion of both has been roughly equal. Diabetes (15.4% vs. 5.6%, p=0.018), chronic anemia (5.5% vs. 0.8%, p=0.04), and emergent admission (48.4% vs. 24.2%, p<0.001) were more prevalent among those with endovascular repair. Endovascular therapy was associated with a lower incidence of complications, lower median length of stay (4 vs. 7 days, p<0.001), and lower rates of discharge to skilled nursing facilities (18.9% vs. 39.2%, p=0.001). There has been an increasing number of treated RAAs in NYS since 2000, with the increase being primarily in those treated by endovascular techniques. Whether this represents a true increase in RAA incidence requiring management or an extension of indications is unknown. Outcomes after endovascular repair were better than those after conventional surgery, although whether this was due to the technique of repair itself or preprocedural selection bias cannot be determined.
本研究的目的是评估纽约州（NYS）接受手术或血管内修复的肾动脉动脉瘤（RAA）患者的治疗变化趋势及预后的决定因素。通过全州规划与研究合作系统数据库，对2000年10月1日至2006年12月31日在NYS接受RAA治疗的患者进行了一项回顾性队列研究。建立了包含医院和患者特征的回归模型，以确定手术或血管内干预后不良事件的预测因素。在此期间，对215例接受RAA修复的患者进行了分析。在多变量分析中，术前死亡的预测因素包括糖尿病（调整优势比[OR]=57.8，95%置信区间[CI] 2.3 - 1,430.1，p = 0.013）、其他动脉瘤的存在（调整OR = 18.5，CI 1.5 - 234.4，p = 0.024）和凝血病（调整OR = 16.9，CI 3.4 - 393.1，p = 0.03），但不包括修复类型。围手术期心脏并发症（调整OR = 16.7，CI 1.4 - 197.1，p = 0.026）和血管装置相关并发症（调整OR = 11.1，CI 1.003 - 123.0，p = 0.049）可预测死亡率。当将有其他动脉瘤的患者排除在分析之外（n = 153）时，没有显著的死亡预测因素。进行了91例血管内修复和124例开放手术修复，随着时间的推移，血管内修复的比例显著增加（p < 0.001），尽管自2003年以来两者的比例大致相等。糖尿病（15.4%对5.6%，p = 0.018）、慢性贫血（5.5%对0.8%，p = 0.04）和急诊入院（48.4%对24.2%，p < 0.001）在接受血管内修复的患者中更为普遍。血管内治疗与较低的并发症发生率、较短的中位住院时间（4天对7天，p < 0.001）以及较低的转至专业护理机构的出院率（18.9%对39.2%，p = 0.001）相关。自2000年以来，NYS接受治疗的RAA患者数量不断增加，主要是通过血管内技术治疗的患者增加。这是代表需要治疗的RAA发病率的真正增加还是适应证的扩大尚不清楚。血管内修复后的预后优于传统手术后的预后，尽管这是由于修复技术本身还是术前选择偏倚尚无法确定。
