European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, University Hospital Maastricht, Maastricht, The Netherlands.
Eur J Vasc Endovasc Surg. 2019 Mar;57(3):340-348. doi: 10.1016/j.ejvs.2018.09.007. Epub 2018 Nov 9.
This study compared the outcomes of open one stage with open two stage repair of type II thoraco-abdominal aortic aneurysms (TAAA).
This retrospective study included 94 patients (68 men) with a mean ± SD age of 54.5 ± 14 years who underwent open type II TAAA repair from March 2006 to January 2016. The mean aneurysm diameter was 65 ± 14.4 mm. The median follow up was 42 months (range 12-96). Seventy-six patients received one stage open repair and 18 patients were treated in two steps: 12 received two open procedures (thoracic and abdominal) and six received hybrid repair (one open and one endovascular procedure). This study focused on the comparison of open one stage and open two stage TAAA repair. The median time between the two steps was 31.5 days (range 1-169).
In hospital mortality after open one stage repair versus open two stage type II repair was 22.4% versus 0% (odds ratio 7.352, 95% confidence interval [CI] 0.884-959.1]; p = .19). The one year survival rate after one stage repair versus open two stage repair was 74.7% (95% CI 62.7-83.3) versus 90.9% (95% CI 50.8-98.7 [p = .225]). The five year survival rate after one stage repair versus open two stage repair was 53.0% (95% CI 37.2-66.5) versus 90.9% (95% CI 50.8-98.7 [p = .141]). The hazard ratio for survival after one stage repair and after open two stage repair was 4.563 (95% CI 96.9-81.4 [p = .137]). Paraplegia was observed after open one stage repair versus open two stage in 10.5% vs. 8% (p = 1). Acute kidney injury requiring permanent dialysis and myocardial infarction were assessed for after open one stage repair and open two stage and were seen in 3.9% vs. 0% (p = 1) and in 5.3% vs. 0% (p = 1), respectively.
Open two stage repair may be recommended as a treatment option for type II TAAAs if anatomically feasible, as it has a lower mortality and similar complication rates to one stage repair.
本研究比较了一期开放手术和二期开放手术治疗 II 型胸腹主动脉瘤（TAAA）的结果。
本回顾性研究纳入了 94 例（68 例男性）患者，平均年龄 54.5±14 岁，均于 2006 年 3 月至 2016 年 1 月接受开放 II 型 TAAA 修复术。平均动脉瘤直径为 65±14.4mm。中位随访时间为 42 个月（范围 12-96 个月）。76 例患者接受一期开放修复，18 例患者接受两期开放手术治疗：12 例患者接受两次开放手术（胸段和腹段），6 例患者接受杂交修复（一次开放手术和一次血管内手术）。本研究重点比较了一期开放和二期开放 TAAA 修复术。两期手术之间的中位时间为 31.5 天（范围 1-169 天）。
一期开放手术后与二期开放手术后 II 型 TAAA 修复的院内死亡率分别为 22.4%和 0%（比值比 7.352，95%置信区间[CI]0.884-959.1；p=0.19）。一期开放手术后与二期开放手术后一年生存率分别为 74.7%（95%CI 62.7-83.3）和 90.9%（95%CI 50.8-98.7[ p=0.225]）。一期开放手术后与二期开放手术后五年生存率分别为 53.0%（95%CI 37.2-66.5）和 90.9%（95%CI 50.8-98.7[ p=0.141]）。一期开放手术后和二期开放手术后的生存风险比为 4.563（95%CI 96.9-81.4[ p=0.137]）。一期开放手术后与二期开放手术后截瘫发生率分别为 10.5%和 8%（p=1）。一期开放手术后与二期开放手术后急性肾损伤需要永久性透析和心肌梗死的发生率分别为 3.9%和 0%（p=1）和 5.3%和 0%（p=1）。
如果解剖学上可行，二期开放手术可能是 II 型 TAAA 的一种治疗选择，因为它的死亡率较低，并发症发生率与一期修复术相似。
