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三级医疗中心经皮与开放股动脉暴露用于血管腔内腹主动脉瘤修复的真实世界经验比较

A Real-World Experience Comparison of Percutaneous and Open Femoral Exposure for Endovascular Abdominal Aortic Aneurysm Repair in a Tertiary Medical Center.

作者信息

Mukherjee Dipankar, Emery Erica, Majeed Rashad, Heshmati Keyvan, Hashemi Homayoun

机构信息

1 Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA.

2 Howard University Hospital, Washington, DC, USA.

出版信息

Vasc Endovascular Surg. 2017 Jul;51(5):269-273. doi: 10.1177/1538574417702774. Epub 2017 May 9.

Abstract

OBJECTIVE

To compare the outcomes of elective percutaneous endovascular aneurysm repair (PEVAR) versus surgical cutdown endovascular aneurysm repair (SEVAR) procedures performed at a tertiary medical center from 2012 to 2015.

METHODS

This is a unique study using procedure data from two vascular surgeons who performed SEVAR in almost every case versus three vascular surgeons who performed PEVAR in all cases except when considered prohibitive on account of circumferential calcification or severe occlusive disease of the common femoral artery or some other technical consideration. Medical records of patients aged 18 years or older undergoing elective PEVAR or SEVAR between January 2012 and December 2015 were reviewed. Differences in readmissions and complications between patients who received PEVAR and those who received SEVAR were assessed using Fisher's exact test. The exact Cochran-Armitage test was used to assess trends in length of stay between the PEVAR and SEVAR group.

RESULTS

A total of 183 patients were analyzed. In total, 132 underwent PEVAR and 51 underwent SEVAR. A statistically significant difference was noted with regard to 30-day readmissions (2.3% vs 13.7%, P = .006) in favor of PEVAR and categorical length of stay tended to be longer in the SEVAR group ( P = .003). The 30-day complication rate was not statistically different (6.8% vs 15.7%, P = .09).

CONCLUSIONS

Surgical cutdown endovascular aneurysm repair results in more readmissions, often related to groin wound complications, which lead to prolonged length of stay and expense. Patients undergoing PEVAR tend to have a shorter length of stay. Overall complication rate was similar in the two groups. We recommend PEVAR for patients with appropriate anatomy.

摘要

目的

比较2012年至2015年在一家三级医疗中心进行的选择性经皮血管腔内动脉瘤修复术(PEVAR)与手术切开血管腔内动脉瘤修复术(SEVAR)的治疗效果。

方法

这是一项独特的研究,使用了两位血管外科医生几乎在所有病例中都进行SEVAR的手术数据,以及三位血管外科医生在除因股总动脉圆周钙化或严重闭塞性疾病或其他技术考虑因素而被认为不可行之外的所有病例中进行PEVAR的手术数据。回顾了2012年1月至2015年12月期间接受选择性PEVAR或SEVAR的18岁及以上患者的病历。使用Fisher精确检验评估接受PEVAR和接受SEVAR的患者在再入院率和并发症方面的差异。使用精确的 Cochr an - Armitage检验评估PEVAR组和SEVAR组之间住院时间的趋势。

结果

共分析了183例患者。其中,132例接受了PEVAR,51例接受了SEVAR。在30天再入院率方面存在统计学显著差异(2.3%对13.7%,P = .006),支持PEVAR,并且SEVAR组的分类住院时间往往更长(P = .003)。30天并发症发生率无统计学差异(6.8%对15.7%,P = .09)。

结论

手术切开血管腔内动脉瘤修复术导致更多的再入院情况,通常与腹股沟伤口并发症有关,这会导致住院时间延长和费用增加。接受PEVAR的患者住院时间往往较短。两组的总体并发症发生率相似。对于解剖结构合适的患者,我们推荐PEVAR。

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