Regional Vascular Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom.
J Vasc Surg. 2013 Feb;57(2):362-7. doi: 10.1016/j.jvs.2012.08.040. Epub 2012 Oct 6.
Abdominal aortic aneurysms that are unsuitable for a standard endovascular repair (EVAR) could be considered for fenestrated endovascular repair (f-EVAR). The aim of this study was to conduct a risk-adjusted retrospective concurrent cohort comparison of f-EVAR and open repair for such aneurysms.
All patients who underwent repair of an abdominal aortic aneurysm that was unsuitable for a standard EVAR due to inadequate neck within one institution between January 2006 and December 2010 were identified. Case notes were retrieved for clinical data, Vascular Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (V-POSSUM) score, and aneurysm morphology. Computed tomography scans were reviewed to establish aneurysm morphology.
A total of 107 patients were identified. The open surgery cohort included 54 patients (35 men) who were a median age of 72 years (interquartile range [IQR], 9.5; range, 60-86 years). The aortic cross-clamp was infrarenal in 20 patients, suprarenal or above in 21, and inter-renal in eight. Postoperatively, 63 major complications were noted in 30 patients, nine of whom required 16 reinterventions. Cumulative hospital stay of the cohort was 1170 days (median, 12; IQR, 13; range, 1-205 days) of which 234 days (median, 28; IQR, 36; range, 1-77 days) were in the intensive therapy unit (ITU). Perioperative mortality was 9.2% (n = 5), exactly as estimated by V-POSSUM. The f-EVAR cohort included 53 patients (47 men) who were a median age of 76 years (IQR, 11.50; range, 55-87 years). Two fenestrations and one scallop was the most frequent configuration (n = 31). Postoperatively, 37 major complications were noted in 18 patients, six requiring reintervention. Hospital stay was 559 days (median, 7; IQR, 4.5; range, 4-64 days), of which 31 days (median, 4; IQR, 10.5; range, 1-15 days) were in the ITU. Two patients died perioperatively (3.7%), resulting in an observed crude absolute risk reduction of 5.5% compared with open repair. The V-POSSUM estimated perioperative death in five patients (9.4%) in the f-EVAR cohort. In a hypothetic scenario of the f-EVAR cohort undergoing open repair, V-POSSUM estimated seven deaths (13.2%), resulting in an estimated risk-adjusted absolute risk reduction due to f-EVAR of 9.5%.
In this group of patients, f-EVAR reduced mortality and morbidity substantially compared with open repair and also reduced total hospital stay and ITU utilization.
不适合标准血管内修复术 (EVAR) 的腹主动脉瘤可考虑采用开窗血管内修复术 (f-EVAR)。本研究旨在对同一机构内 2006 年 1 月至 2010 年 12 月期间因颈部不适合标准 EVAR 的腹主动脉瘤进行风险调整的回顾性同期队列比较，以评估 f-EVAR 和开放修复术的效果。
所有因腹主动脉瘤颈部不适合标准 EVAR 而在同一机构接受修复的患者均被识别。检索病历以获取临床数据、血管生理和手术严重程度评分以评估死亡率和发病率 (V-POSSUM) 评分以及动脉瘤形态。对计算机断层扫描进行回顾以确定动脉瘤形态。
共确定了 107 名患者。开放手术组包括 54 名患者（35 名男性），中位年龄为 72 岁（四分位距 [IQR]，9.5；范围，60-86 岁）。主动脉夹闭在 20 名患者位于肾下，在 21 名患者位于肾上或以上，在 8 名患者位于肾间。术后，30 名患者发生 63 例重大并发症，其中 9 名需要 16 次再次干预。该队列的累计住院时间为 1170 天（中位数，12；IQR，13；范围，1-205 天），其中 234 天（中位数，28；IQR，36；范围，1-77 天）在重症监护病房（ITU）。围手术期死亡率为 9.2%（n=5），与 V-POSSUM 估计值完全一致。f-EVAR 组包括 53 名患者（47 名男性），中位年龄为 76 岁（IQR，11.50；范围，55-87 岁）。最常见的配置是两个开窗和一个扇贝形（n=31）。术后，18 名患者发生 37 例重大并发症，其中 6 例需要再次干预。住院时间为 559 天（中位数，7；IQR，4.5；范围，4-64 天），其中 31 天（中位数，4；IQR，10.5；范围，1-15 天）在 ITU。2 名患者在围手术期死亡（3.7%），与开放修复相比，实际绝对风险降低了 5.5%。V-POSSUM 估计 f-EVAR 组中有 5 名患者（9.4%）在围手术期死亡。在 f-EVAR 组接受开放修复的假设情况下，V-POSSUM 估计有 7 人死亡（13.2%），这表明 f-EVAR 可使死亡率降低 9.5%。
在这组患者中，与开放修复相比，f-EVAR 显著降低了死亡率和发病率，同时还降低了总住院时间和 ICU 使用率。
