Farivar Behzad S, Kalsi Richa, Drucker Charles B, Goldstein Carly B, Sarkar Rajabrata, Toursavadkohi Shahab
Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
J Vasc Surg. 2017 Jul;66(1):95-101. doi: 10.1016/j.jvs.2016.10.124. Epub 2017 Feb 16.
Hypogastric artery embolization (HAE) is associated with significant risk of ischemic complications. We assessed the impact of HAE on 30-day outcomes of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms.
We queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2014 to identify and to compare clinical features, operative details, and 30-day outcomes of EVAR with those of concomitant HAE with EVAR (HAE + EVAR). Multivariate analysis was performed to determine preoperative and intraoperative factors associated with development of significant complications observed in patients with HAE + EVAR.
In a cohort of 5881 patients, 387 (6.6%) underwent HAE + EVAR. Compared with EVAR, a higher incidence of ischemic colitis (2.6% vs 0.9%; P = .002), renal failure requiring dialysis (2.8% vs 1%; P = .001), pneumonia (2.6% vs 1.3%; P = .039), and perioperative blood transfusion (17% vs 13%; P = .024) was noted after HAE + EVAR. Thirty-day thromboembolic events, strokes, myocardial infarction, lower extremity ischemia, reoperation, and readmission rates were not significantly different (P > .05). Mortality at 30 days in HAE + EVAR patients was 4.1% compared with 2.5% with EVAR (P = .044). HAE was independently associated with increased risk of colonic ischemia (adjusted odds ratio, 2.98; 95% confidence interval, 1.44-6.14; P = .003) and renal failure requiring dialysis (adjusted odds ratio, 2.22; 95% confidence interval, 1.09-4.53; P = .029). However, HAE was not an independent predictor of mortality. Average length of hospital stay was 4 ± 8.5 days after HAE + EVAR vs 3.3 ± 5.9 days after EVAR (P = .001).
Concomitant HAE with EVAR is associated with longer and more complicated hospital stays. Ischemic colitis is a rare complication of EVAR. HAE increases the risk of ischemic colitis and renal failure requiring dialysis. This study highlights the importance of hypogastric artery preservation during EVAR.
腹下动脉栓塞术（HAE）与缺血性并发症的显著风险相关。我们评估了HAE对肾下腹主动脉瘤血管内修复术（EVAR）30天预后的影响。
我们查询了2011年至2014年美国外科医师学会国家外科质量改进计划数据库，以识别并比较EVAR与同期HAE联合EVAR（HAE + EVAR）的临床特征、手术细节和30天预后。进行多变量分析以确定与HAE + EVAR患者中观察到的严重并发症发生相关的术前和术中因素。
在5881例患者队列中，387例（6.6%）接受了HAE + EVAR。与EVAR相比，HAE + EVAR术后缺血性结肠炎（2.6%对0.9%；P = .002）、需要透析的肾衰竭（2.8%对1%；P = .001）、肺炎（2.6%对1.3%；P = .039）和围手术期输血（17%对13%；P = .024）的发生率更高。30天血栓栓塞事件、中风、心肌梗死、下肢缺血、再次手术和再入院率无显著差异（P > .05）。HAE + EVAR患者30天死亡率为4.1%，而EVAR患者为2.5%（P = .044）。HAE与结肠缺血风险增加（调整优势比，2.98；95%置信区间，1.44 - 6.14；P = .003）和需要透析的肾衰竭独立相关（调整优势比，2.22；95%置信区间，1.09 - 4.53；P = .029）。然而，HAE不是死亡率的独立预测因素。HAE + EVAR术后平均住院时间为4 ± 8.5天，而EVAR术后为3.3 ± 5.9天（P = .001）。
EVAR同期行HAE与更长且更复杂的住院时间相关。缺血性结肠炎是EVAR的一种罕见并发症。HAE增加了缺血性结肠炎和需要透析的肾衰竭的风险。本研究强调了EVAR期间保留腹下动脉的重要性。
