Section of Vascular Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, CT 06510, USA.
J Vasc Surg. 2011 May;53(5):1210-6. doi: 10.1016/j.jvs.2010.10.135. Epub 2011 Feb 5.
Ruptured descending thoracic aortic aneurysm (rDTAA) is a cardiovascular catastrophe, associated with high morbidity and mortality, which can be managed either by open surgery or thoracic endovascular aortic repair (TEVAR). The purpose of this study is to retrospectively compare the mortality, stroke, and paraplegia rates after open surgery and TEVAR for the management of rDTAA.
Patients with rDTAA treated with TEVAR or open surgery between 1995 and 2010 at seven institutions were identified and included for analysis. The outcomes between both treatment groups were compared; the primary end point of the study was a composite end point of death, permanent paraplegia, and/or stroke within 30 days after the intervention. Multivariate logistic regression analysis was used to identify risk factors for the primary end point.
A total of 161 patients with rDTAA were included, of which 92 were treated with TEVAR and 69 with open surgery. The composite outcome of death, stroke, or permanent paraplegia occurred in 36.2% of the open repair group, compared with 21.7% of the TEVAR group (odds ratio [OR], 0.49; 95% confidence interval [CI], .24-.97; P = .044). The 30-day mortality was 24.6% after open surgery compared with 17.4% after TEVAR (OR, 0.64; 95% CI, .30-1.39; P = .260). Risk factors for the composite end point of death, permanent paraplegia, and/or stroke in multivariate analysis were increasing age (OR, 1.04; 95% CI, 1.01-1.08; P = .036) and hypovolemic shock (OR, 2.47; 95% CI, 1.09-5.60; P = .030), while TEVAR was associated with a significantly lower risk of the composite end point (OR, 0.44; 95% CI, .20-.95; P = .039). The aneurysm-related survival of patients treated with open repair was 64.3% at 4 years, compared with 75.2% for patients treated with TEVAR (P = .191).
Endovascular repair of rDTAA is associated with a lower risk of a composite of death, stroke, and paraplegia, compared with traditional open surgery. In rDTAA patients, endovascular management appears the preferred treatment when this method is feasible.
破裂性降主动脉瘤（rDTAA）是一种心血管灾难，发病率和死亡率都很高，可以通过开放手术或胸主动脉腔内修复术（TEVAR）来治疗。本研究的目的是回顾性比较开放手术和 TEVAR 治疗 rDTAA 的死亡率、卒中和截瘫发生率。
在七个机构，1995 年至 2010 年间接受 TEVAR 或开放手术治疗 rDTAA 的患者被确定并纳入分析。比较两组患者的治疗结果；本研究的主要终点是术后 30 天内死亡、永久性截瘫和/或卒中等复合终点。采用多变量 logistic 回归分析确定主要终点的危险因素。
共纳入 161 例 rDTAA 患者，其中 92 例接受 TEVAR 治疗，69 例接受开放手术治疗。开放修复组的复合结局（死亡、卒中和永久性截瘫）发生率为 36.2%，而 TEVAR 组为 21.7%（比值比 [OR]，0.49；95%置信区间 [CI]，0.24-0.97；P=0.044）。开放手术组 30 天死亡率为 24.6%，而 TEVAR 组为 17.4%（OR，0.64；95%CI，0.30-1.39；P=0.260）。多变量分析中，死亡、永久性截瘫和/或卒中等复合终点的危险因素是年龄增加（OR，1.04；95%CI，1.01-1.08；P=0.036）和低血容量性休克（OR，2.47；95%CI，1.09-5.60；P=0.030），而 TEVAR 与复合终点的风险显著降低相关（OR，0.44；95%CI，0.20-0.95；P=0.039）。开放修复治疗的患者动脉瘤相关生存率为 4 年时 64.3%，而 TEVAR 治疗的患者为 75.2%（P=0.191）。
与传统开放手术相比，rDTAA 的血管内修复与较低的死亡、卒中和截瘫复合风险相关。在 rDTAA 患者中，当可行时，血管内治疗似乎是首选的治疗方法。
