Department of Surgery, Atrium Medical Center Parkstad, Heerlen, The Netherlands.
Eur J Vasc Endovasc Surg. 2011 May;41(5):647-51. doi: 10.1016/j.ejvs.2011.01.005. Epub 2011 Feb 18.
The reported mortality reduction of emergency endovascular aneurysm repair (eEVAR) compared with open repair in patients with a ruptured abdominal aortic aneurysm (rAAA), as observed in observational studies, might be flawed by selection bias based on anatomical suitability for eEVAR. In the present study, we compared mortality in EVAR suitable versus non-EVAR-suitable patients with a ruptured AAA who were all treated with conventional open repair.
In all patients presenting with a suspected rAAA, computed tomography angiography (CTA) scanning was performed. All consecutive patients with a confirmed rAAA on preoperative CTA scan and treated with open repair between April 2002 and April 2008 were included. Anatomical suitability for eEVAR was determined by two blinded independent reviewers. Outcomes evaluated were mortality (intra-operative, 30-day, and 6-month), morbidity, complications requiring re-intervention and length of hospital stay.
A total of 107 consecutive patients presented with a rAAA and underwent preoperative CTA scanning. In 25 patients, eEVAR was performed. In the 82 patients who underwent open repair, CTA showed an EVAR-suitable rAAA in 33 patients (41.8%) and a non-EVAR-suitable rAAA in 49 patients. Thirty-day and 6-month mortality rate was 15/33 (45.5%; 95% confidence interval (CI) 28.1-63.7) and 18/33 (54.5%; 95% CI 36.4-71.9) in the EVAR-suitable group versus 24/49 (49.0%; 95% CI 34.4-63.7) (P=0.75) and 29/49 (59.2%; 95% CI 44.2-73.0) (P=0.68) in the non-EVAR-suitable group, respectively.
The present study suggests that anatomical suitability for EVAR is not associated with lower early and midterm mortality in patients treated with open ruptured AAA repair. Therefore, the reported reduction in mortality between eEVAR and open repair is unlikely due to selection bias based on anatomical AAA configuration.
在观察性研究中，与开放修复相比，急诊血管内修复（eEVAR）在破裂腹主动脉瘤（rAAA）患者中降低死亡率的报道可能存在基于 eEVAR 解剖学适用性的选择偏倚。在本研究中，我们比较了所有接受传统开放修复治疗的 rAAA 患者中 EVAR 适合与不适合患者的死亡率。
所有疑似 rAAA 的患者均行计算机断层血管造影（CTA）扫描。所有在术前 CTA 扫描中确诊为 rAAA 并在 2002 年 4 月至 2008 年 4 月期间接受开放修复的连续患者均被纳入研究。两名独立盲审人员确定 eEVAR 的解剖学适用性。评估的结果包括死亡率（术中、30 天和 6 个月）、发病率、需要再次干预的并发症和住院时间。
共 107 例连续 rAAA 患者行术前 CTA 扫描。25 例患者行 eEVAR。在 82 例接受开放修复的患者中，CTA 显示 33 例（41.8%）为 EVAR 适合 rAAA，49 例为非 EVAR 适合 rAAA。EVAR 适合组的 30 天和 6 个月死亡率分别为 15/33（45.5%；95%置信区间[CI]28.1-63.7）和 18/33（54.5%；95%CI 36.4-71.9），而非 EVAR 适合组的分别为 24/49（49.0%；95%CI 34.4-63.7）（P=0.75）和 29/49（59.2%；95%CI 44.2-73.0）（P=0.68）。
本研究表明，EVAR 的解剖学适用性与接受开放修复的 rAAA 患者的早期和中期死亡率降低无关。因此，eEVAR 和开放修复之间死亡率降低的报道不太可能归因于基于 AAA 解剖结构的选择偏倚。
