Jiang J J, Qing H K, Zhang X M, Zhang X M, Li W, Shen C Y, Li Q L, Jiao Y
Department of Vascular Surgery, Peking University People's Hospital, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2016 Oct 18;48(5):850-854.
To compare total percutaneous access using preclose technique with femoral artery cut-down in endovascular aneurysm repair (EVAR) and assess the safety and feasibility of preclose technique.
In the study, 81 cases undergoing EVAR from Dec. 2011 to Nov. 2014 in Peking University People's Hospital were retrospectively reviewed. Preoperative CT angiography (CTA) showed presence of infrarenal abdominal aortic aneurysm or descending aortic aneurysm in all the cases. The maximum diameter of aneurysm >4.5 cm met the indications for surgical treatment. The conditions of bilateral femoral artery and iliac artery CTA showed were good, and there was no moderate or severe stenosis, nor was there any severe calcification in anterior wall of femoral artery. Not only were the cases fit for percutaneous endovascular aortic aneurysm repair (PEVAR), but also feasible with open endovascular aneurysm repair (OEVAR). According to the intention of the patients about the surgical incision, the cases were divided into group PEVAR and group OEVAR. The data of the general situation, operation time, blood loss, technical success rate, length of hospital stay after procedure and wound complications were analyzed statistically.
In the study, 44 cases (78 incisions) were enrolled in group PEVAR and 37 cases (65 incisions) in group OEVAR. There was no significant difference between the two groups in age, gender, body mass index (BMI), accompanying diseases, average number of stents and outer diameter of stent delivery system. Average operation time of group PEVAR was less than that of group OEVAR [(119.1±102.0) min vs. (163.6±61.9) min, P=0.025]. The blood loss in group PEVAR was less than that in group OEVAR [(64.7±97.0) mL vs. (98.6±88.3) mL], but there was no significant difference (P=0.106). There was no difference in the technical success rate (94.9% vs.95.4%, P=1.000). The average length of hospital stay after procedure was significantly shorter in group PEVAR [(7.8±2.8) d vs.(12.3±7.2) d, P<0.001]. There were 2 cases with subcutaneous hematoma of wound in group PEVAR and 7 cases of wound complications that occurred in group OEVAR including 3 cases with lymphatic leakage, 3 cases with lower limb ischemia and 1 case with subcutaneous hematoma. The analysis showed that PEVAR could reduce the wound complications (2.6%vs.10.8%), but there was no significant difference between the two groups (P=0.079).
Using preclose technique in EVAR is safe and effective. It can shorten the operation time and length of hospital stay after procedure.
比较血管腔内修复术（EVAR）中使用预闭合技术的完全经皮入路与股动脉切开术，并评估预闭合技术的安全性和可行性。
回顾性分析2011年12月至2014年11月在北京大学人民医院接受EVAR的81例患者。术前CT血管造影（CTA）显示所有患者均存在肾下腹主动脉瘤或降主动脉瘤。动脉瘤最大直径>4.5 cm符合手术治疗指征。双侧股动脉和髂动脉CTA显示条件良好，无中度或重度狭窄，股动脉前壁也无严重钙化。这些病例不仅适合经皮血管腔内主动脉瘤修复术（PEVAR），也可行开放性血管腔内动脉瘤修复术（OEVAR）。根据患者对手术切口的意愿，将病例分为PEVAR组和OEVAR组。对两组患者的一般情况、手术时间、出血量、技术成功率、术后住院时间和伤口并发症等数据进行统计学分析。
本研究中，PEVAR组纳入44例（78个切口），OEVAR组纳入37例（65个切口）。两组在年龄、性别、体重指数（BMI）、伴随疾病、平均支架数量和支架输送系统外径方面无显著差异。PEVAR组平均手术时间短于OEVAR组[（119.1±102.0）分钟对（163.6±61.9）分钟，P = 0.025]。PEVAR组出血量少于OEVAR组[（64.7±97.0）毫升对（98.6±88.3）毫升]，但差异无统计学意义（P = 0.106）。技术成功率无差异（94.9%对95.4%，P = 1.000）。PEVAR组术后平均住院时间明显短于OEVAR组[（7.8±2.8）天对（12.3±7.2）天，P<0.001]。PEVAR组有2例伤口皮下血肿，OEVAR组发生7例伤口并发症，包括3例淋巴漏、3例下肢缺血和1例皮下血肿。分析显示PEVAR可减少伤口并发症（2.6%对10.8%），但两组间差异无统计学意义（P = 0.079）。
在EVAR中使用预闭合技术安全有效。它可缩短手术时间和术后住院时间。
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