Aziz Faisal, Azab Andrew, Schaefer Eric, Reed Amy B
Division of Vascular Surgery, Penn State Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA.
Offices of Medical Education, Pennsylvania State University College of Medicine, Hershey, PA.
Ann Vasc Surg. 2016 Aug;35:147-55. doi: 10.1016/j.avsg.2016.01.021. Epub 2016 May 26.
Acute renal failure (ARF) after surgical treatment of ruptured abdominal aortic aneurysm (AAA) is an independent predictor of post-operative mortality. Open repair for ruptured AAA has been the gold standard treatment; however, there has been a recent trend in increased utilization of endovascular repair (EVAR) for treatment of ruptured AAA. The purpose of this study was to retrospectively review and compare the incidence of ARF among patients treated with open versus endovascular repair of ruptured AAA.
American College of Surgeons National Surgical Quality Improvement Program database was searched for surgeries performed for AAA during 2005-2010. Patients' demographics and co-morbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, congestive heart failure, myocardial infarction, peripheral arterial disease) were collected. Incidence of ARF after surgery was reviewed. We also collected American Society for Anesthesiologists scores, operating times, functional status, post-operative complications, and mortality.
Of total 2179 operations for ruptured AAA, incidence of mortality within first 30 days after operation was 17% after EVAR for ruptured AAA and 33.2% after open repair of ruptured AAA. Incidence of ARF was 6.9% after EVAR for ruptured AAA and 13.5% after open repair of ruptured AAA. Odds ratio for mortality after open repair was 1.94 (confidence interval [CI] 1.51-2.49) when compared with EVAR (P < 0.001), and odds ratio for developing ARF after EVAR was 1.62 (CI 1.14-2.29) as compared with open AAA repair (P < 0.05) in multivariable logistic regression models. Open repair of ruptured AAA and totally dependent functional status were associated with post-operative mortality and ARF.
Incidence of mortality and post-operative ARF for ruptured AAA is significantly higher when treated with open repair, as compared to EVAR. Totally dependent functional status was associated with post-operative mortality and ARF.
腹主动脉瘤（AAA）破裂手术治疗后的急性肾衰竭（ARF）是术后死亡率的独立预测因素。开放性修复一直是破裂AAA的金标准治疗方法；然而，近年来，血管内修复（EVAR）在治疗破裂AAA中的应用呈增加趋势。本研究的目的是回顾性分析和比较接受开放性与血管内修复治疗破裂AAA患者的ARF发生率。
检索美国外科医师学会国家外科质量改进计划数据库中2005 - 2010年间进行的AAA手术。收集患者的人口统计学和合并症（糖尿病、高血压、慢性阻塞性肺疾病、充血性心力衰竭、心肌梗死、外周动脉疾病）。回顾手术后ARF的发生率。我们还收集了美国麻醉医师协会评分、手术时间、功能状态、术后并发症和死亡率。
在总共2179例破裂AAA手术中，破裂AAA的EVAR术后30天内死亡率为17%，破裂AAA开放性修复术后为33.2%。破裂AAA的EVAR术后ARF发生率为6.9%，破裂AAA开放性修复术后为13.5%。在多变量逻辑回归模型中，与EVAR相比，开放性修复术后死亡的优势比为1.94（置信区间[CI]1.51 - 2.49）（P < 0.001），与开放性AAA修复相比，EVAR术后发生ARF的优势比为1.62（CI 1.14 - 2.29）（P < 0.05）。破裂AAA的开放性修复和完全依赖的功能状态与术后死亡率和ARF相关。
与EVAR相比，破裂AAA采用开放性修复治疗时，死亡率和术后ARF的发生率显著更高。完全依赖的功能状态与术后死亡率和ARF相关。
