Rudarakanchana N, Hamady M, Harris S, Afify E, Gibbs Rgj, Bicknell C D, Jenkins M P
Vascular Surgery Unit, Imperial Healthcare NHS Trust , London , UK.
Department of Surgery, Imperial College London , London , UK.
Ann R Coll Surg Engl. 2018 Apr;100(4):316-321. doi: 10.1308/rcsann.2018.0014. Epub 2018 Feb 27.
Objective Despite centralisation of the provision of vascular care, not all areas in England and Wales are able to offer emergency treatment for patients with acute conditions affecting the aorta proximal to the renal arteries. While cardiothoracic centres have made network arrangements to coordinate care for the repair of type A dissections, a similar plan for vascular care is lacking. This study investigates early outcomes in patients with ruptured suprarenal aortic aneurysm or dissection (rSRAD) transferred to a specialist centre. Methods Retrospective observational study over a five-year period (2009-2014) assessing outcomes of patients with ruptured sRAD diagnosed at their local hospital and then transferred to a tertiary centre capable of offering such treatment. Results Fifty-two patients (median age 73 years, 32 male) with rSRAD were transferred and a further four died during transit. The mean distance of patient transfer was 35 miles (range 4-211 miles). One patient did not undergo intervention due to frailty and two died before reaching the operating theatre. A total of 23 patients underwent endovascular repair, 9 hybrid repair and 17 open surgery. Median follow-up was 12 months (range 1-43 months). Complications included paraplegia (n = 3), stroke (n = 2), type IA endoleak (n = 4); 30-day and in-hospital mortality were 16% and 27%. For patients discharged alive from hospital, one-year survival was 67%. Conclusions Although the number of patients with rSRAD is low and those who are transferred alive are a self-selecting group, this study suggests that transfer of such patients to a specialist vascular centre is associated with acceptable mortality rates following emergency complex aortic repair.
目的 尽管血管护理服务已实现集中化，但英格兰和威尔士并非所有地区都能为患有影响肾动脉近端主动脉急性病症的患者提供紧急治疗。虽然心胸中心已制定网络安排以协调A型夹层修复的护理工作，但缺乏类似的血管护理计划。本研究调查了转至专科中心的肾上腺上主动脉瘤破裂或夹层（rSRAD）患者的早期结局。方法 进行为期五年（2009 - 2014年）的回顾性观察研究，评估在当地医院诊断为sRAD破裂并随后转至能够提供此类治疗的三级中心的患者结局。结果 52例rSRAD患者（中位年龄73岁，32例男性）被转运，另有4例在转运途中死亡。患者转运的平均距离为35英里（范围4 - 211英里）。1例患者因身体虚弱未接受干预，2例在到达手术室前死亡。共有23例患者接受了血管内修复，9例接受了杂交修复，17例接受了开放手术。中位随访时间为12个月（范围1 - 43个月）。并发症包括截瘫（n = 3）、中风（n = 2）、IA型内漏（n = 4）；30天和住院死亡率分别为16%和27%。对于出院存活的患者，一年生存率为67%。结论 尽管rSRAD患者数量较少，且存活转运的患者是一个自我选择的群体，但本研究表明，将此类患者转运至专科血管中心与紧急复杂主动脉修复后的可接受死亡率相关。
