Siracuse Jeffrey J, Krafcik Brianna M, Farber Alik, Kalish Jeffrey A, McChesney Andrew, Rybin Denis, Doros Gheorghe, Eslami Mohammad H
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, Mass.
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University, School of Medicine, Boston, Mass.
J Vasc Surg. 2017 Apr;65(4):1023-1028. doi: 10.1016/j.jvs.2016.08.115. Epub 2016 Dec 13.
Although endovascular repair of ruptured abdominal aortic aneurysms (rAAAs) is increasingly more prevalent and may yield better results, open repair of rAAAs is still commonly performed. Our goal was to assess the contemporary practice patterns and outcomes of open repair of rAAA.
The 2011-2014 American College of Surgeons National Surgical Quality Improvement Program targeted open AAA database was queried for all rAAAs. Patient characteristics, presentation, aneurysm details, and operative details were analyzed to identify factors that may affect outcome in this population of patients.
We identified 404 patients who underwent open repair of rAAA. The average age was 72 ± 9.4 years, and 76.2% were male. There were 230 (56.9%) patients who presented with hypotension. The operative approach was retroperitoneal in 16.3% of cases. The proximal extents of the aneurysms were infrarenal (52.5%), juxtarenal (24.3%), pararenal (4.2%), and suprarenal (8.2%). The distal extents were aortic (38.6%), common iliac artery (34.2%), and external or internal iliac artery (8.9%). Renal, visceral, and lower extremity revascularization was performed in 6.4%, 2.2%, and 7.9% of patients, respectively. Thirty-day mortality was 35.6%, and postoperative complications included cardiac (18.3%), pulmonary (42.3%), wound complications (6.7%), acute renal failure (17.3%), and ischemic colitis (9.4%). Postoperative length of stay was 13.1 ± 12.7 days, and 30-day readmission was 4.5%. Predictors of 30-day mortality were transperitoneal approach (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.38-7.89; P < .001), hypotension at presentation (OR, 2.03; 95% CI, 1.2-3.56; P = .007), and age (OR, 1.05; 95% CI, 1.02-1.09; P = .001). Transperitoneal approach also increased the risk of postoperative cardiac complications (OR, 3.25; 95% CI, 1.01-10.4; P = .047). Postoperative pulmonary complications were predicted by chronic obstructive pulmonary disease (OR, 2.06; 95% CI, 1.07-3.94; P = .03) and hypotension at presentation (OR, 1.77; 95% CI, 1.06-2.96; P = .03).
The majority of contemporary open rAAA repairs were performed for infrarenal aneurysms. Transperitoneal approach, hypotension, and chronic obstructive pulmonary disease were associated with higher mortality and postoperative complications. Thirty-day mortality after rAAA was lower compared with historical data.
尽管破裂腹主动脉瘤（rAAA）的血管腔内修复术越来越普遍，且可能产生更好的效果，但rAAA的开放修复术仍被广泛应用。我们的目标是评估rAAA开放修复术的当代实践模式和结果。
查询2011 - 2014年美国外科医师学会国家外科质量改进计划的目标开放AAA数据库中的所有rAAA病例。分析患者特征、临床表现、动脉瘤细节和手术细节，以确定可能影响该患者群体预后的因素。
我们确定了404例行rAAA开放修复术的患者。平均年龄为72±9.4岁，76.2%为男性。230例（56.9%）患者就诊时出现低血压。16.3%的病例采用腹膜后手术入路。动脉瘤的近端范围为肾下型（52.5%）、近肾型（24.3%）、肾旁型（4.2%）和肾上型（8.2%）。远端范围为主动脉型（38.6%）、髂总动脉型（34.2%）和髂外或髂内动脉型（8.9%）。分别有6.4%、2.2%和7.9%的患者进行了肾、内脏和下肢血管重建。30天死亡率为35.6%，术后并发症包括心脏并发症（18.3%）、肺部并发症（42.3%）、伤口并发症（6.7%）、急性肾衰竭（17.3%）和缺血性结肠炎（9.4%）。术后住院时间为13.1±12.7天，30天再入院率为4.5%。30天死亡率的预测因素为经腹手术入路（比值比[OR]，3.3；95%置信区间[CI]，1.38 - 7.89；P <.001）、就诊时低血压（OR，2.03；95% CI，1.2 - 3.56；P =.007）和年龄（OR，1.05；95% CI，1.02 - 1.09；P =.001）。经腹手术入路也增加了术后心脏并发症的风险（OR，3.25；95% CI，1.01 - 10.4；P =.047）。术后肺部并发症的预测因素为慢性阻塞性肺疾病（OR，2.06；95% CI，1.07 - 3.94；P =.03）和就诊时低血压（OR，1.77；95% CI，1.06 - 2.96；P =.03）。
当代大多数rAAA开放修复术针对的是肾下型动脉瘤。经腹手术入路、低血压和慢性阻塞性肺疾病与更高的死亡率和术后并发症相关。与历史数据相比，rAAA术后30天死亡率较低。
