开放手术与血管腔内修复腘动脉瘤的当代疗效
Contemporary outcomes of open and endovascular popliteal artery aneurysm repair.
作者信息
Leake Andrew E, Avgerinos Efthymios D, Chaer Rabih A, Singh Michael J, Makaroun Michel S, Marone Luke K
机构信息
Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
出版信息
J Vasc Surg. 2016 Jan;63(1):70-6. doi: 10.1016/j.jvs.2015.08.056. Epub 2015 Oct 21.
OBJECTIVE
The purpose of this study was to evaluate contemporary practice and outcomes of open repair (OR) or endovascular repair (ER) for popliteal artery aneurysms (PAAs).
METHODS
Consecutive patients with PAA treated at one institution from January 2006 to March 2014 were reviewed under an Institutional Review Board-approved protocol. Demographics, indications, anatomic characteristics, and outcomes were collected. Standard statistical methods were used.
RESULTS
A total of 186 PAAs were repaired in 156 patients (110 ORs, 76 ERs) with a mean age of 71 ± 11 years, and most were male (96%). Mean follow-up was 34.9 ± 28.6 months for OR and 28.3 ± 25.8 months for ER (P = .12). Comorbidities were similar between groups. OR was used in more patients with PAA thrombosis (41.8% vs 5.3%; P < .001), acute ischemia (24.5% vs 9.2%; P = .010), and ischemic rest pain (34.5% vs 6.6%; P < .001). Mean tibial (Society for Vascular Surgery) runoff score was 5.0 for OR vs 3.3 for ER (P = .006). OR was associated with increased 30-day complications (22% vs 2.6%; P < .001) and mean postoperative stay (5.8 vs 1.6 days; P < .001). There was no difference in 30-day mortality (OR, 1.8%; ER, 0%; P = .56) or major amputation rate (OR, 3.7%; ER, 1.3%; P = .65). Primary, primary assisted, and secondary patency rates were similar at 3 years (OR, 79.5%, 83.7%, and 85%; ER, 73.2%, 76.3%, and 83%; P = NS). Among 130 patients presenting electively without acute ischemia or thrombosed PAA (63 ORs and 67 ERs), OR had better 3-year primary patency (88.3% vs 69.8%; P = .030) and primary assisted patency (90.2% vs 73.5%; P = .051) but similar secondary patency (90.2% vs 82%; P = .260). ER thrombosis was noted in 8 of 24 patients treated in 2006-2008 (33%; mean time to failure, 49 months) but in only 4 of 51 patients treated in 2009-2013 (7.8%; mean time to failure, 30 months), suggesting a steep learning curve.
CONCLUSIONS
ER is a safe and durable option for PAA, with lower complication rates and a shorter length of stay. OR has superior primary patency in patients treated electively but no difference in midterm secondary patency and amputations.
目的
本研究旨在评估腘动脉瘤（PAA）开放修复术（OR）或血管腔内修复术（ER）的当代实践及疗效。
方法
回顾2006年1月至2014年3月在同一机构接受治疗的连续性PAA患者，研究遵循机构审查委员会批准的方案。收集患者的人口统计学资料、手术指征、解剖学特征及治疗结果。采用标准统计学方法。
结果
156例患者共修复186个PAA（开放修复110例，血管腔内修复76例），平均年龄71±11岁，多数为男性（96%）。开放修复组平均随访34.9±28.6个月，血管腔内修复组平均随访28.3±25.8个月（P = 0.12）。两组患者合并症情况相似。开放修复术用于更多合并PAA血栓形成（41.8% 对5.3%；P < 0.001）、急性缺血（24.5% 对9.2%；P = 0.010）及缺血性静息痛（34.5% 对6.6%；P < 0.001）的患者。开放修复组胫部（血管外科学会）平均流出道评分为5.0，血管腔内修复组为3.3（P = 0.006）。开放修复术与30天并发症发生率增加相关（22% 对2.6%；P < 0.001）及术后平均住院时间延长相关（5.8天对1.6天；P < 0.001）。30天死亡率（开放修复术为1.8%，血管腔内修复术为0%；P = 0.56）及大截肢率（开放修复术为3.7%，血管腔内修复术为1.3%；P = 0.65）无差异。3年时的一期通畅率、一期辅助通畅率及二期通畅率相似（开放修复术分别为79.5%、83.7%和85%，血管腔内修复术分别为73.2%、76.3%和83%；P = 无显著性差异）。在130例非急性缺血或血栓形成的择期手术患者中（开放修复术63例，血管腔内修复术67例），开放修复术的3年一期通畅率更好（88.3% 对69.8%；P = 0.030）及一期辅助通畅率更好（9月2% 对73.5%；P = 0.051），但二期通畅率相似（90.2% 对82%；P = 0.260）。2006 - 2008年治疗的24例血管腔内修复术患者中有8例发生血栓形成（33%；平均失败时间49个月），但2009 - 2013年治疗的51例患者中仅4例发生血栓形成（7.8%；平均失败时间30个月），提示学习曲线较陡。
结论
血管腔内修复术是治疗PAA的一种安全、持久的选择，并发症发生率较低，住院时间较短。开放修复术在择期手术患者中一期通畅率更高，但中期二期通畅率及截肢率无差异。
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