Gupta Prateek K, Sundaram Abhishek, Kent K Craig
Department of Surgery, University of Tennessee Health Science Center and Methodist University Hospital, Memphis, Tenn.
Department of Surgery, CHI Health Creighton University Medical Center, Omaha, Neb.
J Vasc Surg. 2015 Jul;62(1):22-6. doi: 10.1016/j.jvs.2015.02.027. Epub 2015 Apr 30.
Although placement of an open iliac conduit for endovascular aortic aneurysm repair (EVAR) is generally felt to result in higher morbidity and mortality, published literature is scarce. Our objective was to assess 30-day outcomes after elective EVAR with an open iliac conduit using a multi-institutional database.
Patients who underwent elective EVAR (n = 14,339) for abdominal aortic aneurysm were identified from the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2011 database. Univariable and multivariable logistic regression analyses were performed.
An open iliac conduit was used in 231 patients (1.6%), and the remainder had femoral exposure or percutaneous EVAR. Women comprised 32% of patients with iliac conduits in contrast to 17% of those without iliac conduits. Patients with iliac conduits were older and had a lower body mass index. Univariable analysis showed patients with open iliac conduits had a higher incidence of postoperative pneumonia (3.0% vs 1.1%), ventilator dependence (4.8% vs 1.0%), renal failure (3.0% vs 0.7%), cardiac arrest or myocardial infarction (5.2% vs 1.1%), return to the operating room (9.1% vs 3.7%), major morbidity (16.0 vs 6.6%), and death (3.0% vs 0.9%). On multivariable analysis, the use of open iliac conduits was associated with higher risk of 30-day mortality (odds ratio, 2.7; 95% confidence interval, 1.2-6.0) and 30-day major morbidity (odds ratio, 2.3; 95% confidence interval, 1.6-3.3).
Patients with open iliac conduits for EVAR are more likely to be female and have higher postoperative morbidity and mortality. For patients with complex iliac artery disease, conduits are a viable alternative after EVAR to be performed, albeit at an increased risk. These data do suggest the need for lower-profile grafts and other alternative strategies for navigating complex iliac artery disease.
尽管一般认为在血管腔内修复腹主动脉瘤（EVAR）时放置开放髂血管导管会导致更高的发病率和死亡率，但相关的公开文献却很匮乏。我们的目的是利用一个多机构数据库评估采用开放髂血管导管进行择期EVAR术后30天的结果。
从美国外科医师学会国家外科质量改进计划2005年至2011年的数据库中识别出接受腹主动脉瘤择期EVAR的患者（n = 14,339）。进行单变量和多变量逻辑回归分析。
231例患者（1.6%）使用了开放髂血管导管，其余患者采用股动脉暴露或经皮EVAR。使用髂血管导管的患者中女性占32%，而未使用髂血管导管的患者中女性占17%。使用髂血管导管的患者年龄更大，体重指数更低。单变量分析显示，使用开放髂血管导管的患者术后肺炎发生率更高（3.0%对1.1%）、呼吸机依赖率更高（4.8%对1.0%）、肾衰竭发生率更高（3.0%对0.7%）、心脏骤停或心肌梗死发生率更高（5.2%对1.1%）、返回手术室的比例更高（9.1%对3.7%）、严重并发症发生率更高（16.0对6.6%）以及死亡率更高（3.0%对0.9%）。多变量分析显示，使用开放髂血管导管与30天死亡率的更高风险相关（比值比，2.7；95%置信区间，1.2 - 6.0）以及30天严重并发症的更高风险相关（比值比，2.3；95%置信区间，1.6 - 3.3）。
采用开放髂血管导管进行EVAR的患者更可能为女性，术后发病率和死亡率更高。对于患有复杂髂动脉疾病的患者，尽管风险增加，但在EVAR术后使用导管是一种可行的选择。这些数据确实表明需要更小型化的移植物和其他应对复杂髂动脉疾病的替代策略。
