Ten Bosch J A, Willigendael E M, Kruidenier L M, de Loos E R, Prins M H, Teijink J A W
Department of Surgery, Atrium Medical Centre Parkstad, PO Box 4446, 6401 CX, Heerlen, The Netherlands.
Vascular. 2012 Apr;20(2):72-80. doi: 10.1258/vasc.2011.oa0302. Epub 2012 Mar 27.
The aim of the paper is to prospectively describe early and mid-term outcomes for emergency endovascular aneurysm repair (eEVAR) versus open surgery in acute abdominal aortic aneurysms (aAAAs), both unruptured (symptomatic) and ruptured. We enrolled all consecutive patients treated for aAAA at our center between April 2002 and April 2008. The main outcome parameters were 30-day, 6- and 12-month mortality (all-cause and aneurysm-related). Two hundred forty patients were enrolled in the study. In the unruptured aAAA group (n = 111), 47 (42%) underwent eEVAR. The 30-day, 6- and 12-month mortality rates were 6, 13 and 15% in the eEVAR group versus 11% (NS), 13% (NS) and 16% (NS) in the open group, respectively. In the ruptured aAAA group (n = 129), 25 (19%) underwent eEVAR (mortality rates: 20, 28 and 36%, respectively) compared with 104 (81%) patients who underwent open surgery (mortality rates: 45% (P = 0.021), 60% (P = 0.004) and 63% (P = 0.014), respectively). In conclusion, the present study showed a reduced 30-day, 6- and 12-month mortality of eEVAR compared with open surgery in all patients with aAAA, mainly due to a lower mortality in the ruptured aAAA group. Late aneurysm-related mortality occurred only in the eEVAR group.
本文旨在前瞻性地描述急诊血管内动脉瘤修复术（eEVAR）与开放手术治疗急性腹主动脉瘤（aAAA，包括未破裂[有症状]和破裂的）的早期和中期结果。我们纳入了2002年4月至2008年4月在本中心接受aAAA治疗的所有连续患者。主要结局参数为30天、6个月和12个月的死亡率（全因死亡率和动脉瘤相关死亡率）。240例患者纳入本研究。在未破裂aAAA组（n = 111）中，47例（42%）接受了eEVAR。eEVAR组的30天、6个月和12个月死亡率分别为6%、13%和15%，而开放手术组分别为11%（无统计学差异）、13%（无统计学差异）和16%（无统计学差异）。在破裂aAAA组（n = 129）中，25例（19%）接受了eEVAR（死亡率分别为20%、28%和36%），相比之下，104例（81%）患者接受了开放手术（死亡率分别为45%[P = 0.021]、60%[P = 0.004]和63%[P = 0.014]）。总之，本研究表明，与开放手术相比，所有aAAA患者接受eEVAR后的30天、6个月和12个月死亡率均有所降低，主要原因是破裂aAAA组的死亡率较低。晚期动脉瘤相关死亡率仅发生在eEVAR组。
