Shukla Ankur J, Eid Raymond, Fish Larry, Avgerinos Efthymios, Marone Luke, Makaroun Michel, Chaer Rabih A
University of Pittsburgh Medical Center, Pittsburgh, Pa.
University of Pittsburgh Medical Center, Pittsburgh, Pa.
J Vasc Surg. 2015 Jun;61(6):1442-7. doi: 10.1016/j.jvs.2015.01.005. Epub 2015 Mar 7.
The treatment outcomes of ruptured visceral artery aneurysms (rVAAs) have been sparsely characterized, with no clear comparison between different treatment modalities. The purpose of this paper was to review the perioperative and long-term outcomes of open and endovascular interventions for intact visceral artery aneurysms (iVAAs) and rVAAs.
This was a retrospective review of all treated VAAs at one institution from 2003 to 2013. Patient demographics, aneurysm characteristics, management, and subsequent outcomes (technical success, mortality, reintervention) and complications were recorded.
The study identified 261 patients; 181 patients were repaired (77 ruptured, 104 intact). Pseudoaneurysms were more common in rVAAs (81.8% vs 35.3% for iVAAs; P < .001). The rVAAs were smaller than the iVAAs (20.7 mm vs 27.5 mm; P = .018), and their most common presentation was abdominal pain; 29.7% were hemodynamically unstable. Endovascular intervention was the initial treatment modality for 67.4% (75.3% for rVAAs, 61.5% for iVAAs). The perioperative complication rate was higher for rVAAs (13.7% vs 1% for iVAAs; P = .003), as was mortality at 30 days (13% vs 0% for iVAAs; P = .001), 1 year (32.5% for rVAAs vs 4.1% for iVAAs; P < .001), and 3 years (36.4% for rVAAs vs 8.3% for iVAAs; P < .001). Lower 30-day mortality was noted with endovascular repair for rVAAs (7.4% vs 28.6% open; P = .025). Predictors of mortality for rVAAs included age (odds ratio, 1.04; P = .002), whereas endovascular repair was protective (odds ratio, 0.43; P = .037). Mean follow-up was 26.2 months, and Kaplan-Meier estimates of survival were higher for iVAAs at 3 years (88% vs 62% for rVAAs; P = .045). The 30-day reintervention rate was higher for rVAAs (7.7% vs 19.5% for iVAAs; P = .019) but was similar between open and endovascular repair (8.2% vs 15%; P = NS).
rVAAs have significant mortality. Open and endovascular interventions are equally durable for elective repair of VAAs, but endovascular interventions for rVAAs result in lower morbidity and mortality. Aggressive treatment of pseudoaneurysms is electively recommended at diagnosis regardless of size.
内脏动脉动脉瘤破裂（rVAA）的治疗结果鲜有描述，不同治疗方式之间尚无明确比较。本文旨在回顾开放性和血管内介入治疗完整内脏动脉动脉瘤（iVAA）和rVAA的围手术期及长期结果。
对2003年至2013年在一家机构接受治疗的所有VAA患者进行回顾性研究。记录患者的人口统计学资料、动脉瘤特征、治疗方法以及随后的结果（技术成功率、死亡率、再次干预）和并发症。
该研究共纳入261例患者；181例患者接受了修复治疗（77例破裂，104例完整）。假性动脉瘤在rVAA中更为常见（rVAA为81.8%，iVAA为35.3%；P <.001）。rVAA比iVAA小（20.7 mm对27.5 mm；P =.018），其最常见的表现为腹痛；29.7%的患者血流动力学不稳定。血管内介入是67.4%患者的初始治疗方式（rVAA为75.3%，iVAA为61.5%）。rVAA的围手术期并发症发生率更高（rVAA为13.7%，iVAA为1%；P =.003），30天死亡率（rVAA为13%，iVAA为0%；P =.001）、1年死亡率（rVAA为32.5%，iVAA为4.1%；P <.001）和3年死亡率（rVAA为36.4%，iVAA为8.3%；P <.001）也是如此。rVAA血管内修复的30天死亡率较低（7.4%对开放性修复的28.6%；P =.025）。rVAA死亡率的预测因素包括年龄（比值比，1.04；P =.002），而血管内修复具有保护作用（比值比，0.43；P =.037）。平均随访时间为26.2个月，iVAA的3年Kaplan-Meier生存估计值更高（rVAA为62%，iVAA为88%；P =.045）。rVAA的30天再次干预率更高（rVAA为7.7%，iVAA为19.5%；P =.019），但开放性修复和血管内修复之间相似（8.2%对15%；P =无显著性差异）。
rVAA具有显著的死亡率。开放性和血管内介入治疗对VAA的择期修复同样持久，但rVAA的血管内介入治疗可降低发病率和死亡率。无论大小，建议在诊断时对假性动脉瘤进行积极治疗。
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