O'Keeffe Shane D, Davenport Dan, Endean Eric D, Xenos Eleftherios S, Sorial Ehab E, Minion David J
University of Kentucky Medical Center, 800 Rose Street, Room C217, Lexington, KY 40536, USA.
Ann Vasc Surg. 2010 Jan;24(1):28-33. doi: 10.1016/j.avsg.2009.09.003.
Most endovascular abdomincal aortic aneurysm (AAA) repairs (EVARs) performed in the United States utilize a bifurcated configuration. The purpose of this study was to examine the effect of alternate graft configurations on early outcomes during EVAR.
Patients in the National Surgical Quality Improvement Program (NSQIP) participant use file who underwent elective EVAR for AAA from 2005 to 2007 were stratified by configuration using CPT codes. Bifurcated configurations (CPT 34802, 34803, 34804) were compared to straight configurations such as tube or aortouni-iliac grafts (CPT 34800, 34805). Preoperative risk factors, intraoperative variables, 30-day outcome measures, and length of stay were compared. Composite morbidity included patients experiencing one or more of 21 complications defined by NSQIP protocol. Student's t-test and analyses of variance were used to compare variables.
There were 3,264 patients who underwent EVAR, including 2,864 bifurcated endografts and 400 straight endografts. Composite morbidity was greater in patients receiving straight endografts compared to those receiving bifurcated endografts (15.2% vs. 9.3%, p < 0.001). Length of stay was greater in the "straight" cohort as well (4.9 + or - 6.9 vs. 3.3 + or - 5.6, p < 0.001). There was a trend toward increased mortality in the "straight" cohort, but it did not reach statistical significance (2% vs. 0.9%, p = 0.054). After controlling for the top 11 NSQIP predictors of mortality in vascular patients, graft configuration remained significant in the multivariable analysis for morbidity (odds ratio [OR] = 1.55, 95% confidence interval [CI[ 1.13-2.12, p = 0.006) and length of stay but not mortality (OR = 1.63, 95% CI 0.70-3.80, p = 0.263).
EVAR using a tube or aortouni configuration is associated with increased complications and length of stay. These poorer outcomes may be related to factors that lead surgeons to choose these approaches.
在美国，大多数腹主动脉瘤腔内修复术（EVAR）采用分叉型装置。本研究旨在探讨不同移植物构型对EVAR早期疗效的影响。
利用现行程序编码（CPT），将2005年至2007年参加美国国立外科质量改进计划（NSQIP）且接受择期腹主动脉瘤腔内修复术的患者按装置构型进行分层。将分叉型装置（CPT 34802、34803、34804）与直管型装置（如直管或主动脉单髂移植物，CPT 34800、34805）进行比较。比较术前危险因素、术中变量、30天疗效指标及住院时间。综合并发症包括发生一项或多项由NSQIP方案定义的21种并发症的患者。采用学生t检验和方差分析比较变量。
共有3264例患者接受了腹主动脉瘤腔内修复术，其中2864例采用分叉型腔内移植物，400例采用直管型腔内移植物。接受直管型腔内移植物的患者综合并发症发生率高于接受分叉型腔内移植物的患者（15.2%对9.3%，p<0.001）。“直管型”队列的住院时间也更长（4.9±6.9天对3.3±5.6天，p<0.001）。“直管型”队列的死亡率有上升趋势，但未达到统计学显著性（2%对0.9%，p=0.054）。在对血管疾病患者中NSQIP确定的前11项死亡率预测因素进行校正后，移植物构型在多变量分析中对并发症发生率（比值比[OR]=1.55，95%置信区间[CI]1.13 - 2.12，p=0.006）和住院时间仍具有显著性，但对死亡率无显著性（OR=1.63，95%CI 0.70 - 3.80，p=0.263）。
采用直管或主动脉单髂构型的腹主动脉瘤腔内修复术与并发症增加及住院时间延长相关。这些较差的疗效可能与促使外科医生选择这些方法的因素有关。
