Behrendt Christian-Alexander, Dayama Anand, Debus Eike Sebastian, Heidemann Franziska, Matolo Nathaniel M, Kölbel Tilo, Tsilimparis Nikolaos
Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
San Joaquin General Hospital, French Camp, CA.
Ann Vasc Surg. 2017 Nov;45:206-212. doi: 10.1016/j.avsg.2017.05.037. Epub 2017 Jun 7.
Treatment reality of abdominal aortic aneurysm (AAA) is changing. Up to date, approximately 65% of intact AAA and 30% of ruptured AAA are treated endovascularly. As most comparative studies focus upon mortality and few major complications, some outcomes as lower extremity ischemia (LEI) after invasive AAA repair are often underreported. However, there is evidence for a worse outcome of patients suffering from this kind of complication.
Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) vascular surgery targeted module from 2011 to 2014, we identified all patients undergoing endovascular aortic repair (EVAR) and open aortic repair (OAR) for AAA to illuminate the incidence and outcome of LEI after AAA repair.
In total, 185 patients (1.9%) developed LEI after AAA repair. 1.6% of all patients showed LEI after treatment of asymptomatic or symptomatic intact AAA, compared with 4.8% of ruptured AAA repair (P < 0.001). Operation time, male gender, current smoking, and increased creatinine levels (>1.5 mg/dL) were associated with an increased likelihood of exhibiting LEI. No statistically significant differences between EVAR versus OAR were noted in the multivariate model. If LEI occurred, length of hospital stay (6 vs. 2 days, P < 0.001) and mortality (20.5 vs. 4.6%, P < 0.001) was significantly higher as compared with the patients without LEI. Furthermore, 30-day mortality and most major complications were more common if LEI occurred.
In this specialized analysis regarding LEI after AAA repair up to 2% develop this severe ischemic complication. Since the occurrence of LEI is associated with significantly worse outcome, future research and strategies to avoid this complication is needed.
腹主动脉瘤（AAA）的治疗现状正在发生变化。目前，约65%的未破裂AAA和30%的破裂AAA采用血管腔内治疗。由于大多数比较研究关注死亡率和少数主要并发症，一些侵袭性AAA修复术后的下肢缺血（LEI）等结果往往报告不足。然而，有证据表明患有这种并发症的患者预后较差。
利用美国外科医师学会2011年至2014年国家外科质量改进计划（NSQIP）血管外科针对性模块，我们确定了所有接受AAA血管腔内主动脉修复（EVAR）和开放主动脉修复（OAR）的患者，以阐明AAA修复术后LEI的发生率和结局。
共有185例患者（1.9%）在AAA修复术后发生LEI。在无症状或有症状的未破裂AAA治疗后，1.6%的患者出现LEI，而破裂AAA修复后为4.8%（P<0.001）。手术时间、男性、当前吸烟以及肌酐水平升高（>1.5mg/dL）与发生LEI的可能性增加相关。多变量模型中未发现EVAR与OAR之间存在统计学显著差异。如果发生LEI，与未发生LEI的患者相比，住院时间（6天对2天，P<0.001）和死亡率（20.5%对4.6%，P<0.001）显著更高。此外，如果发生LEI，30天死亡率和大多数主要并发症更为常见。
在这项关于AAA修复术后LEI的专门分析中，高达2%的患者发生这种严重的缺血性并发症。由于LEI的发生与明显更差的结局相关，因此需要未来的研究和策略来避免这种并发症。
