Gupta Prateek K, Kempe Kelly, Brahmbhatt Reshma, Gupta Himani, Montes Jorge, Forse R Armour, Stickley Shaun M, Rohrer Michael J
1 Division of Vascular and Endovascular Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
2 Methodist Le Bonheur Healthcare, Memphis, TN, USA.
Vasc Endovascular Surg. 2017 Aug;51(6):357-362. doi: 10.1177/1538574417703562. Epub 2017 May 17.
Outcomes after endovascular repair (EVAR) of ruptured abdominal aortic aneurysms (rAAAs) have been widely published. There is, however, controversy on the role of the use of aortouniiliac endoprosthesis (AUI) versus modular or unibody bifurcated endoprosthesis (MUB) for repair of rAAAs. We study and compare 30-day outcomes after use of AUI and MUB for all rAAAs focusing specifically on patients with instability.
Patients who underwent EVAR for rAAA (n = 425) using AUI (n = 55; 12.9%) and MUB (n = 370; 87.1%) were identified from the American College of Surgeons' National Surgical Quality Improvement Program (2005-2010) database. Univariable and multivariable logistic regression analyses were performed.
No significant difference ( P > .5) was seen in comorbidities between patients who underwent EVAR with AUI or MUB; there was also no change in endoprosthesis use from 2005 to 2010 ( P = .7). Patients who underwent EVAR with AUI more commonly had a history of peripheral arterial procedure (10.9% vs 4.6%; P = .053) and preoperative transfusion of >4 U packed red blood cells (18.2% vs 6.8%; P = .004). Use of AUI versus MUB was associated with more 30-day wound complications (16.4% vs 6.2%; P = .01), return to operating room (38.2% vs 20.0%; P = .003), and mortality (34.5% vs 21.4%; P = .03). On multivariable analysis, use of AUI was associated with an increased risk of 30-day mortality (odds ratio: 2.4; 95% confidence interval: 1.1-5.3). On subanalysis of the cohort for only the patients with unstable rAAA (n = 159; AUI = 29 and MUB = 130), 30-day mortality for AUI versus MUB was still higher but not statistically significant (44.8% vs 32.3%; P = .2).
Endovascular repair for ruptured AAA using aortouniliac endoprosthesis is associated with higher 30-day mortality than using modular or unibody bifurcated endoprosthesis.
腹主动脉瘤破裂（rAAA）的血管腔内修复（EVAR）后的结果已被广泛报道。然而，对于使用主动脉单髂内支架（AUI）与模块化或一体式分叉内支架（MUB）修复rAAA的作用存在争议。我们研究并比较了使用AUI和MUB修复所有rAAA后的30天结果，特别关注不稳定患者。
从美国外科医师学会国家外科质量改进计划（2005 - 2010年）数据库中识别出接受rAAA的EVAR治疗的患者（n = 425），其中使用AUI的患者（n = 55；12.9%）和使用MUB的患者（n = 370；87.1%）。进行单变量和多变量逻辑回归分析。
接受AUI或MUB的EVAR治疗的患者在合并症方面无显著差异（P > 0.5）；2005年至2010年内支架的使用也无变化（P = 0.7）。接受AUI的EVAR治疗的患者更常具有外周动脉手术史（10.9%对4.6%；P = 0.053）和术前输注超过4单位浓缩红细胞（18.2%对6.8%；P = 0.004）。与使用MUB相比，使用AUI与更多的30天伤口并发症（16.4%对6.2%；P = 0.01）、返回手术室（38.2%对20.0%；P = 0.003）和死亡率（34.5%对21.4%；P = 0.03）相关。在多变量分析中，使用AUI与30天死亡率增加的风险相关（比值比：2.4；95%置信区间：1.1 - 5.3）。在仅针对不稳定rAAA患者的队列亚分析中（n = 159；AUI = 29，MUB = 130），AUI与MUB的30天死亡率仍然较高，但无统计学意义（44.8%对32.3%；P = 0.2）。
与使用模块化或一体式分叉内支架相比，使用主动脉单髂内支架进行腹主动脉瘤破裂的血管腔内修复与更高的30天死亡率相关。
