Singh M J, Hager E, Mapara K, Chaer R, Marone L, Leers S, Makaroun M
Vascular Surgery Division University of Pittsburgh Medical Center Pittsburgh, PA, USA -
J Cardiovasc Surg (Torino). 2014 Apr;55(2):137-49.
The advent of endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysms. EVAR has evolved into the preferred treatment for abdominal aortic aneurysms with suitable anatomy. Several randomized clinical trials have confirmed that EVAR reduces short-term morbidity and mortality. Despite vast improvements in diagnostic imaging, open surgical repair techniques and the care of critically ill patients over the past two decades rupture of abdominal aortic aneurysms still carries an extremely high morbidity and mortality. To improve outcomes in treatment of rAAA a movement has occurred away from open repair and toward EVAR as a paradigm shift that may help to improve otherwise dismal results. In the past 10 years, numerous studies including meta-analyses, administrative databases and randomized control trials have investigated the presumed advantages of EVAR over open repair. This review summarizes the world wide experience for ruptured AAA repair and addresses the role for standardization of care with the use of aortic aneurysm protocols.
血管内动脉瘤修复术（EVAR）的出现彻底改变了腹主动脉瘤的治疗方式。EVAR已发展成为适合解剖结构的腹主动脉瘤的首选治疗方法。多项随机临床试验证实，EVAR可降低短期发病率和死亡率。尽管在过去二十年中，诊断成像、开放手术修复技术以及危重症患者护理方面有了巨大进步，但腹主动脉瘤破裂的发病率和死亡率仍然极高。为了改善破裂性腹主动脉瘤（rAAA）的治疗效果，出现了一种从开放修复转向EVAR的趋势，这是一种范式转变，可能有助于改善原本糟糕的结果。在过去10年中，包括荟萃分析、行政数据库和随机对照试验在内的众多研究探讨了EVAR相对于开放修复的假定优势。本综述总结了全球范围内破裂性腹主动脉瘤修复的经验，并探讨了使用主动脉瘤治疗方案实现标准化护理的作用。
