Silingardi Roberto, Azzoni Ilaria, Giuliani Enrico, Saitta Giuseppe, Gennai Stefano, Coppi Gioachino
Department of Vascular Surgery, Nuovo Ospedale S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy.
Department of Anesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy.
Ann Vasc Surg. 2015;29(4):751-7. doi: 10.1016/j.avsg.2014.11.011. Epub 2015 Jan 28.
To compare nephrotoxic and radiation exposure during elective endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms in a selected patient cohort treated with 2 different infrarenal endograft types: the unibody and modular.
Procedural data were retrospectively collected in a single center, case-controlled study. From January 2010 to January 2012, patients treated with elective EVAR were analyzed. Patients treated for thoracoabdominal aneurysms, aortic dissection, aortoiliac aneurysms, and pseudoaneurysms were excluded. The remaining subjects were divided according to the endograft type: group A treated with a unibody endograft type (60 patients) and group B (57 patients) treated with a modular endograft type. Outcome measures included total procedural time, total fluoroscopy time, and volume of contrast medium.
All end points for group A and B were statistically significantly different; median surgical procedure duration was 75 vs. 105 min (P < 0.0001), median volume of iodine contrast injected was 85 vs. 170 mL (P < 0.0001), and median fluoroscopy time was 350 vs. 780 sec (P < 0.0001).
The overall EVAR procedural duration, fluoroscopy time, and volume of contrast medium infusion were significantly reduced in the group treated with the unibody endografts. These results seem to suggest that the unibody endograft may reduce patient risk of nephrotoxic action of the contrast medium, especially important in patients with existing renal insufficiency, and may reduce ionizing radiation exposure for both the patients and operators.
在一组接受两种不同类型肾下腔内移植物（一体式和模块化）治疗的特定患者队列中，比较腹主动脉瘤择期血管内动脉瘤修复术（EVAR）期间的肾毒性和辐射暴露情况。
在一项单中心病例对照研究中回顾性收集手术数据。分析2010年1月至2012年1月期间接受择期EVAR治疗的患者。排除接受胸腹主动脉瘤、主动脉夹层、主髂动脉瘤和假性动脉瘤治疗的患者。其余受试者根据腔内移植物类型进行分组：A组接受一体式腔内移植物治疗（60例患者），B组（57例患者）接受模块化腔内移植物治疗。观察指标包括总手术时间、总透视时间和造影剂用量。
A组和B组的所有终点在统计学上均有显著差异；中位手术持续时间为75分钟对105分钟（P < 0.0001），中位碘造影剂注射量为85毫升对170毫升（P < 0.0001），中位透视时间为350秒对780秒（P < 0.0001）。
接受一体式腔内移植物治疗的组中，总体EVAR手术持续时间、透视时间和造影剂输注量均显著减少。这些结果似乎表明，一体式腔内移植物可能降低患者发生造影剂肾毒性作用的风险，这在已有肾功能不全的患者中尤为重要，并且可能减少患者和术者的电离辐射暴露。
