Emory University School of Medicine, Division of Vascular Surgery and Endovascular Therapy, Atlanta, GA, USA.
J Am Coll Surg. 2013 Aug;217(2):263-9. doi: 10.1016/j.jamcollsurg.2013.03.021. Epub 2013 Jun 13.
Endovascular treatment (ER) of renal artery aneurysms (RAA) has been widely used recently due to its assumed lower morbidity and mortality compared with open surgery (OS). The purpose of this study was to investigate the outcomes of OS and ER, and compare long-term renal function.
Data from 2000 to 2012 were retrospectively collected to identify patients who were treated for RAA in a single institution. Morbidity, mortality, freedom from reinterventions, and renal function were compared between OS and ER for RAA.
Forty-four RAA repairs were identified in 40 patients (28 women, mean age ± SD 54 ± 13 years). Twenty RAA were repaired with OS (45%) and 24 RAA (55%) with ER. Mean aneurysm sizes were 2.5 ± 1.5 cm (OS) and 2.2 ± 2.2 cm (ER; p = 0.66). Endovascular repair included coil embolization with or without stent placement in 19 patients (79%) and stent grafts in 4 (17%). Open surgery included excision or aneurysmorrhaphy of the aneurysm in 11 kidneys (55%), graft interposition or bypass in 4 (20%), and 4 nephrectomies (20%). There was 1 technical failure in each group. Comorbidities were similar between the 2 groups (American Society of Anesthesiologists III-IV: OS, 40%; ER, 58%; p = 0.44). Endovascular repair and OR had equivalent perioperative morbidity (any complication OS, 15%, ER, 17%, p = 1.0) and no mortality (OS, 0%, ER, 0%). Endovascular repair was associated with shorter hospitalization (OS, 6.3 ± 2.5; ER, 2 ± 3.4 days, p < 0.001). Mean follow-ups were 21 ± 32 months (OS) and 27 ± 36 months (ER). A 30% reduction in glomerular filtration rate occurred in 12.5% of OS patients and 9.1% of ER patients (p = 1.00). Freedom from reintervention at 12 and 24 months were OS, 82%/82% and ER, 82%/74%, respectively (log-rank-test = 0.23).
Endovascular repair of RAA is as safe and effective as open repair in selected patients with appropriate anatomy. There was no difference in decline in renal function between OS and ER.
由于腔内治疗（ER）相较于开放手术（OS）具有假定的更低发病率和死亡率，因此最近已经广泛应用于治疗肾动脉动脉瘤（RAA）。本研究旨在探讨 OS 和 ER 的结果，并比较长期肾功能。
回顾性收集 2000 年至 2012 年的数据，以确定在一家机构接受 RAA 治疗的患者。比较 OS 和 ER 治疗 RAA 的发病率、死亡率、免于再干预和肾功能。
40 名患者中有 44 例 RAA 修复（28 名女性，平均年龄±标准差 54±13 岁）。20 例 RAA 采用 OS（45%）修复，24 例 RAA 采用 ER（55%）修复。平均动脉瘤大小为 2.5±1.5cm（OS）和 2.2±2.2cm（ER；p=0.66）。腔内修复包括 19 例（79%）的线圈栓塞伴或不伴支架置入和 4 例（17%）的支架移植物。OS 包括 11 例（55%）的动脉瘤切除术或动脉瘤修补术、4 例（20%）的移植物间置或旁路术和 4 例（20%）的肾切除术。每组各有 1 例技术失败。两组患者的合并症相似（美国麻醉医师协会 III-IV：OS，40%；ER，58%；p=0.44）。ER 和 OS 的围手术期发病率相当（任何并发症 OS，15%；ER，17%；p=1.0），且无死亡率（OS，0%；ER，0%）。ER 与较短的住院时间相关（OS，6.3±2.5；ER，2±3.4 天，p<0.001）。平均随访时间为 21±32 个月（OS）和 27±36 个月（ER）。OS 患者中有 12.5%和 ER 患者中有 9.1%的肾小球滤过率下降 30%（p=1.00）。12 个月和 24 个月时，OS 的无再干预率分别为 82%/82%，ER 分别为 82%/74%（对数秩检验=0.23）。
在适当解剖的患者中，腔内修复 RAA 与开放修复一样安全有效。OS 和 ER 之间肾功能下降无差异。
