Floros Nikolaos, Papadakis Marios, Wagenhäuser Markus Udo, Duran Mansur, Simon Florian, Schelzig Hubert, Oberhuber Alexander
Department of Vascular and Endovascular Surgery, University Hospital Dusseldorf, Dusseldorf, Germany.
Department of Plastic Surgery, HELIOS Clinic Wuppertal, University Hospital Witten-Herdecke, Wuppertal, Germany.
Ann Vasc Surg. 2017 Aug;43:144-150. doi: 10.1016/j.avsg.2017.04.002. Epub 2017 May 4.
Inflammatory abdominal aortic aneurysms (IAAAs) are rare clinical entities with an exaggerated inflammatory component. The aim of this study is to report outcomes of a single-center 10-year experience in open surgical management of IAAA and to compare the results with noninflammatory, atherosclerotic abdominal aortic aneurysms (non-IAAAs).
We retrospectively reviewed the medical records of 18 patients with IAAA selected out of patients with AAA who underwent open surgery in the Department of Vascular and Endovascular Surgery at the University Hospital Dusseldorf from January 2006 to December 2015. These patients were matched with controls, selected from a prospectively retained database of patients with AAA undergoing open surgery during the study period. A 1:2 case-control match regarding age, gender, and year of treatment was performed. We analyzed both groups for preoperative parameters, intraoperative findings, and early postoperative outcomes.
The 2 groups showed considerable similarities with no significant differences in the clinical features. Both groups outlined comparable aneurysm size (62 vs. 56 mm); however, the mean preoperative C-reactive protein was found to be significantly elevated in the study group (mean value: 2.6 vs. 0.9 mg/dL, P < 0.05). Most patients were operated using a standard transperitoneal median laparotomy approach; only 1 patient of each group was operated using a left retroperitoneal approach. There was no significant difference in operation time (190 vs. 194 min) and 30-day mortality 0%. The in-hospital mortality was 11% in the study group and 0% in the control group. We found a significant higher complication rate in the study group 10 (56%) vs. 12 (33%). The major complications were also more frequent in the study group 4 (22%) vs. 6 (16.7%). IAAA showed a statistically significant longer length of intensive care unit and hospital stay when compared with non-IAAA (7 and 20 days vs. 2 and 14 days, P < 0.05). IAAAs outlined a significantly greater transfusion requirement for erythrocytes and fresh frozen plasma than non-IAAA.
Open surgical treatment of IAAA guarantees a regression of the inflammatory process in most patients, which was detected through ultrasound in follow-up examination, although the approach to the surgical site is highly demanding. IAAA exhibits clear gender predominance and is associated with significantly higher transfusion requirement, early morbidity, and length of stay.
炎性腹主动脉瘤（IAAA）是一种罕见的临床疾病，具有过度的炎症成分。本研究的目的是报告单中心10年开放手术治疗IAAA的结果，并将结果与非炎性、动脉粥样硬化性腹主动脉瘤（非IAAA）进行比较。
我们回顾性分析了2006年1月至2015年12月在杜塞尔多夫大学医院血管与血管内外科接受开放手术的AAA患者中选出的18例IAAA患者的病历。这些患者与对照组进行匹配，对照组选自研究期间接受开放手术的AAA患者的前瞻性保留数据库。根据年龄、性别和治疗年份进行1:2病例对照匹配。我们分析了两组的术前参数、术中发现和术后早期结果。
两组在临床特征上有相当大的相似性，无显著差异。两组的动脉瘤大小相当（62对56mm）；然而，研究组术前C反应蛋白平均水平显著升高（平均值：2.6对0.9mg/dL，P<0.05）。大多数患者采用标准经腹正中剖腹术入路；每组仅1例患者采用左腹膜后入路。手术时间（190对194分钟）和30天死亡率0%无显著差异。研究组住院死亡率为11%，对照组为0%。我们发现研究组的并发症发生率显著更高，分别为10例（56%）对12例（33%）。主要并发症在研究组也更常见，分别为4例（22%）对6例（16.7%）。与非IAAA相比，IAAA在重症监护病房和住院时间上有统计学显著更长（分别为7天和20天对2天和14天，P<0.05）。IAAA对红细胞和新鲜冰冻血浆的输血需求明显高于非IAAA。
IAAA的开放手术治疗可保证大多数患者炎症过程消退，这在随访超声检查中得以发现，尽管手术部位的入路要求很高。IAAA表现出明显的性别优势，且与显著更高的输血需求、早期发病率和住院时间相关。
