ten Bosch Jan A, Legemate Dink A, Teijink Joep A W
Atrium Medisch Centrum Parkstad, afd. Vaatchirurgie, Heerlen, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A506.
Currently, two treatment options for ruptured abdominal aortic aneurysms (AAA) are available: conventional open surgical repair and endovascular minimally invasive repair. Open repair carries a significant morbidity and mortality rate, most probably due to the combined effects of general anaesthesia and surgical exposure. Based on anatomical characteristics as assessed by CT scan, approximately half of the patients with a ruptured AAA are eligible for endovascular minimally invasive repair. The majority of comparative studies show a clear trend towards a lower perioperative mortality rate for endovascular repair compared to open surgery (18-24% and 34-38%, respectively) and more rapid recovery. However, these mainly observational studies show considerable heterogeneity. Furthermore, potential selection bias, where patients with a more favourable anatomic and haemodynamic profile are more likely to be selected for endovascular repair, makes a proper comparison barely possible.The potential benefits of endovascular repair over open surgery are currently being evaluated in a large randomised study.
目前，腹主动脉瘤（AAA）破裂有两种治疗选择：传统的开放手术修复和血管内微创修复。开放修复具有较高的发病率和死亡率，这很可能是全身麻醉和手术暴露共同作用的结果。根据CT扫描评估的解剖特征，大约一半的AAA破裂患者适合进行血管内微创修复。大多数比较研究表明，与开放手术相比，血管内修复的围手术期死亡率有明显降低的趋势（分别为18 - 24%和34 - 38%），且恢复更快。然而，这些主要是观察性研究，显示出相当大的异质性。此外，潜在的选择偏倚，即解剖和血流动力学特征更有利的患者更有可能被选择进行血管内修复，使得进行恰当的比较几乎不可能。目前，一项大型随机研究正在评估血管内修复相对于开放手术的潜在益处。
