Locham Satinderjit S, Grimm Joshua C, Arhuidese Isibor J, Nejim Besma, Obeid Tammam, Black James H, Malas Mahmoud B
Division of Vascular Surgery, The Johns Hopkins Medical Institute, Baltimore, MD.
Division of Vascular Surgery, The Johns Hopkins Medical Institute, Baltimore, MD.
Ann Vasc Surg. 2017 Oct;44:128-135. doi: 10.1016/j.avsg.2017.02.015. Epub 2017 May 10.
Open aneurysm repair (OAR) remains the gold standard for treating ruptured thoracoabdominal aortic aneurysms (TAAAs). The aim of our study is to compare the 30-day postoperative outcomes among patients with ruptured TAAA undergoing OAR versus endovascular aneurysm repair.
Using the National Surgical Quality Improvement Program database (2006-2015), we identified patients who underwent OAR and endovascular repair for a ruptured TAAA. Postoperative outcomes of interest included mortality, renal failure, stroke, and cardiopulmonary complications. The independent impact of repair type on each of the aforementioned outcomes was examined after robust risk adjustment.
A total of 206 ruptured TAAA repairs were performed [OAR 144 (70%) versus endovascular 62 (30%)]. The majority of patients were male (53 %) and white (77%). The comorbidities were similar between the 2 groups. On average, the operative time of OAR was approximately 3 hr longer than endovascular repair (P < 0.001). The mortality was similar between the 2 groups (OAR 38% versus endovascular 26%, P = 0.09). Compared with endovascular repair, OAR was associated with higher rates of renal and pulmonary complications (32% vs. 13%, P = 0.004; 58% vs. 37%, P = 0.007, respectively). After adjusting for high-risk patient characteristics, endovascular repair, in comparison with OAR, was associated with a 66% reduction of pulmonary injury and 70% reduction in renal failure (odds ratio [OR] 0.34, 95% CI 0.16-0.73, P = 0.005; OR 0.30, 95% CI 0.11-0.82, P = 0.02).
Our study reflects the contemporary outcomes following the repair of ruptured TAAA. Despite similar mortality, the endovascular approach was associated with a significant reduction in the risk of renal failure and pulmonary injury.
开放性动脉瘤修复术（OAR）仍是治疗破裂性胸腹主动脉瘤（TAAA）的金标准。我们研究的目的是比较接受OAR与血管腔内动脉瘤修复术的破裂性TAAA患者术后30天的结局。
利用国家外科质量改进计划数据库（2006 - 2015年），我们确定了接受OAR和血管腔内修复术治疗破裂性TAAA的患者。感兴趣的术后结局包括死亡率、肾衰竭、中风和心肺并发症。在进行稳健的风险调整后，研究了修复类型对上述各结局的独立影响。
共进行了206例破裂性TAAA修复术[OAR 144例（70%），血管腔内修复术62例（30%）]。大多数患者为男性（53%）和白人（77%）。两组的合并症相似。平均而言，OAR的手术时间比血管腔内修复术长约3小时（P < 0.001）。两组的死亡率相似（OAR为38%，血管腔内修复术为26%，P = 0.09）。与血管腔内修复术相比，OAR与更高的肾脏和肺部并发症发生率相关（分别为32%对13%，P = 0.004；58%对37%，P = 0.007）。在调整了高危患者特征后，与OAR相比，血管腔内修复术与肺损伤减少66%和肾衰竭减少70%相关（优势比[OR] 0.34，95%置信区间0.16 - 0.73，P = 0.005；OR 0.30，95%置信区间0.11 - 0.82，P = 0.02）。
我们的研究反映了破裂性TAAA修复术后的当代结局。尽管死亡率相似，但血管腔内治疗方法与肾衰竭和肺损伤风险的显著降低相关。
