Division of Thoracic and Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida 32610-0129, USA.
Ann Thorac Surg. 2010 Dec;90(6):1833-9. doi: 10.1016/j.athoracsur.2010.08.008.
The US Food and Drug Administration approved the first thoracic aneurysm endograft in 2005. However, because the United States lacks a thoracic aneurysm endovascular repair registry, implications of Food and Drug Administration endograft approval on surgical management of thoracic aneurysms in clinical practice are unknown.
Retrospective review of thoracic aneurysm repair rates for 2000 to 2007 and analysis of patient characteristics and complications for 2006 and 2007 cohorts uses the National Inpatient Sample. International Classification of Diseases, 9th Revision codes were used to identify unruptured descending thoracic aneurysm cases undergoing either thoracic endovascular aortic repair (39.73) or open repair (38.45).
Thoracic aneurysm open repair averaged 3.3 per million from 2000 to 2002 and increased to 5.6 per million in 2003 with introduction of 16 slice computed tomographic scanners. In 2005 endovascular repair was 1.2 repairs per million, which increased dramatically to 6.1 repairs per million in 2006. In 2007, endovascular repair decreased to 4.8 repairs per million while the open repair rate was 3.1 repairs per million. The 2006 and 2007 open repair cohorts had more favorable baseline characteristics compared with the endovascular cohort. Open repair mortality was significantly greater than endovascular mortality in 2006 (estimated relative risk, 8.48; 95% confidence interval 3.03 to 23.75), but not in 2007 (estimated relative risk, 0.71; 95% confidence interval 0.12 to 4.24). Length of stay was greater for open repair in 2006 and 2007.
Thoracic endovascular aortic repair has been rapidly adopted in the United States resulting in increased treatment of thoracic aortic aneurysms. Despite older age and comorbidities, endovascular repair had better outcomes and shorter hospital stays.
美国食品和药物管理局于 2005 年批准了首个胸主动脉瘤血管内移植物。然而，由于美国缺乏胸主动脉瘤血管内修复登记处，食品和药物管理局批准的血管内移植物对临床实践中胸主动脉瘤的手术治疗的影响尚不清楚。
回顾性分析 2000 年至 2007 年胸主动脉瘤修复率，并使用国家住院患者样本分析 2006 年和 2007 年队列的患者特征和并发症。使用国际疾病分类第 9 版代码识别接受胸主动脉腔内修复术（39.73）或开放修复术（38.45）的未破裂降胸主动脉瘤病例。
2000 年至 2002 年，胸主动脉瘤开放修复平均每百万人 3.3 例，2003 年引入 16 层 CT 扫描仪后增加至每百万人 5.6 例。2005 年血管内修复每百万人 1.2 例，2006 年急剧增加至每百万人 6.1 例。2007 年，血管内修复降至每百万人 4.8 例，而开放修复率为每百万人 3.1 例。与血管内组相比，2006 年和 2007 年开放修复组的基线特征更有利。2006 年开放修复死亡率明显高于血管内死亡率（估计相对风险 8.48；95%置信区间 3.03 至 23.75），但 2007 年并非如此（估计相对风险 0.71；95%置信区间 0.12 至 4.24）。2006 年和 2007 年开放修复的住院时间均较长。
胸主动脉腔内修复术在美国迅速得到采用，导致胸主动脉瘤的治疗增加。尽管年龄较大且合并症较多，但血管内修复的结果更好，住院时间更短。
