Barnes R, Kassianides X, Barakat H, Mironska E, Lakshminarayan R, Chetter I C
Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull York Medical School, University of Hull, 1st Floor Main Tower Block, Anlaby Road, Hull, HU3 2JZ, UK,
World J Surg. 2014 May;38(5):1223-6. doi: 10.1007/s00268-013-2393-y.
Perioperative mortality of open repair of ruptured abdominal aortic aneurysms (rAAA) remains unacceptably high: 30-day mortality ≈ 40 %. This study aimed to assess, quantify, and determine the consequences of anatomic suitability for endovascular repair of rAAA.
A retrospective analysis of the prospectively maintained database identified patients with rAAA.
Preoperative CT scans were assessed for anatomic suitability for emergency EVAR and precluding factors recorded. Demographic information was collected and analysed for all patients.
A total of 141 patients underwent open surgical repair of rAAA. Forty-six patients had preoperative CT scans suitable for reconstruction. Morphological measurements indicated that 41 % would have been anatomically suitable for EVAR. Suitability was associated with lower mortality rates than unsuitability: 0, 11, and 20 % (24 h, 30 days, and 1 year respectively) versus 11, 33, and 59 % (statistically significant at 1 year; p = 0.02). The groups were comparable excepting diabetes incidence, which was higher in those suitable for EVAR (p = 0.003).
A minority of patients with ruptured AAA are anatomically suitable for EVAR. Anatomical suitability appears to identify patients at low risk from open surgery. Whether this is due to technically less demanding open surgery is unknown. This may be resolved by the IMPROVE trial results, which are eagerly awaited.
腹主动脉瘤破裂（rAAA）开放修复术的围手术期死亡率仍然高得令人难以接受：30天死亡率约为40%。本研究旨在评估、量化并确定rAAA血管腔内修复术的解剖学适宜性的后果。
对前瞻性维护的数据库进行回顾性分析，以确定rAAA患者。
评估术前CT扫描对急诊血管腔内修复术的解剖学适宜性，并记录排除因素。收集并分析所有患者的人口统计学信息。
共有141例患者接受了rAAA开放手术修复。46例患者术前CT扫描适合重建。形态学测量表明，41%的患者在解剖学上适合血管腔内修复术。适宜组的死亡率低于不适宜组：分别为0%、11%和20%（24小时、30天和1年），而不适宜组为11%、33%和59%（1年时具有统计学意义；p = 0.02）。除糖尿病发病率外，两组具有可比性，适合血管腔内修复术的患者糖尿病发病率更高（p = 0.003）。
少数rAAA患者在解剖学上适合血管腔内修复术。解剖学适宜性似乎可以识别出开放手术风险较低的患者。这是否是由于开放手术技术要求较低尚不清楚。这可能会通过备受期待的IMPROVE试验结果得到解决。
