Oliveira-Pinto José, Sousa Joel, Mansilha Armando
Departamento de Angiologia e Cirurgia Vascular. Centro Hospitalar de São João. Porto; Departamento de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto; Serviço de Angiologia e Cirurgia Vascular. Hospital CUF Porto. Porto, Portugal.
Departamento de Angiologia e Cirurgia Vascular. Centro Hospitalar de São João. Porto. Departamento de Cirurgia e Fisiologia. Faculdade de Medicina. Universidade do Porto. Porto. Serviço de Angiologia e Cirurgia Vascular. Hospital CUF Porto. Porto, Portugal.
Acta Med Port. 2018 Apr 30;31(4):213-218. doi: 10.20344/amp.10275.
Endovascular aneurysm repair for ruptured abdominal aortic aneurysm has been increasingly advocated due to short term benefits. Most observational studies point towards survival advantage for endovascular aneurysm repair over open repair. However, randomized clinical trials already performed did not support this data. The aim of this review is to compare post-operative outcomes between endovascular aneurysm repair and open surgery for the treatment of ruptured abdominal aortic aneurysms.
MEDLINE databases were searched to access outcomes after endovascular aneurysm repair for ruptured abdominal aortic aneurysm and open repair for ruptured abdominal aneurysm repair. All the randomized controlled trials were included. Large and contemporary observational studies were also considered.
Thirty day mortality ranged between 18% - 53% for endovascular aneurysm repair for ruptured abdominal aortic aneurysm and between 24% - 53% for open repair. Post-operative complications ranged between 33% - 77% for endovascular aneurysm repair for ruptured abdominal aortic aneurysm and 37% - 80% for open repair. In hospital stay ranged between 8.5 and 14.3 days for endovascular aneurysm repair for ruptured abdominal aortic aneurysm and between 12.2 and 20.5 days for open repair. Intensive care unit days ranged between 1.75 - 4.2 days for endovascular aneurysm repair for ruptured abdominal aortic aneurysm and 2.5 - 6.3 days for open repair.
Survival benefit is found for endovascular aneurysm repair for ruptured abdominal aortic aneurysm in most observational studies, but those are not reproduced by randomized controlled trials data. However, endovascular aneurysm repair for ruptured abdominal aortic aneurysm showed less post-operative complications and hospitalization days.
Endovascular aneurysm repair for ruptured abdominal aortic aneurysm should be considered as first line of treatment in centers with expertise and proper facilities.
由于短期获益，血管内动脉瘤修复术治疗破裂性腹主动脉瘤越来越受到推崇。大多数观察性研究表明，与开放修复术相比，血管内动脉瘤修复术具有生存优势。然而，已开展的随机临床试验并不支持这一数据。本综述的目的是比较血管内动脉瘤修复术与开放手术治疗破裂性腹主动脉瘤的术后结局。
检索MEDLINE数据库，以获取血管内动脉瘤修复术治疗破裂性腹主动脉瘤及开放修复术治疗破裂性腹主动脉瘤的结局。纳入所有随机对照试验。也考虑大型当代观察性研究。
血管内动脉瘤修复术治疗破裂性腹主动脉瘤的30天死亡率在18%至53%之间，开放修复术的30天死亡率在24%至53%之间。血管内动脉瘤修复术治疗破裂性腹主动脉瘤的术后并发症发生率在33%至77%之间，开放修复术的术后并发症发生率在37%至80%之间。血管内动脉瘤修复术治疗破裂性腹主动脉瘤的住院时间在8.5至14.3天之间，开放修复术的住院时间在12.2至20.5天之间。血管内动脉瘤修复术治疗破裂性腹主动脉瘤的重症监护病房天数在1.75至4.2天之间，开放修复术的重症监护病房天数在2.5至6.3天之间。
大多数观察性研究发现，血管内动脉瘤修复术治疗破裂性腹主动脉瘤具有生存获益，但随机对照试验数据并未重现这一结果。然而，血管内动脉瘤修复术治疗破裂性腹主动脉瘤的术后并发症和住院天数较少。
在具备专业技术和适当设施的中心，血管内动脉瘤修复术治疗破裂性腹主动脉瘤应被视为一线治疗方法。
