Service de Chirurgie Vasculaire, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, Faculté de Médecine de Marseille, Aix-Marseille Université, Marseille, France.
Service de Chirurgie Vasculaire, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, Faculté de Médecine de Marseille, Aix-Marseille Université, Marseille, France.
J Vasc Surg. 2019 Sep;70(3):683-690. doi: 10.1016/j.jvs.2018.11.041. Epub 2019 Mar 6.
The objective of this study was to compare surgical risk and early and late mortality of patients treated for anatomically classified juxtarenal aortic aneurysms (JRAs) by fenestrated endovascular aneurysm repair (F-EVAR) or open surgical repair (OSR) during a period when the two treatments were available and to validate an institutional algorithm for JRA repair.
We retrospectively included all patients treated electively in our center between January 2005 and December 2015 for JRAs classified into three anatomic categories, excluding suprarenal aneurysms. Lee score and American Society of Anesthesiologists (ASA) class evaluated preoperative surgical risk. We compared clinical and radiologic parameters between the patients treated by F-EVAR and those treated by OSR. The primary study end point was 30-day mortality. We also compared 5-year survival.
From 2005 to 2015, there were 191 patients separated into two groups, one treated by OSR (n = 134; mean age, 69 years) and the other treated by F-EVAR (n = 57; mean age, 74 years). Patients of the F-EVAR group were significantly older (P = .001). Intensive care unit length of stay was significantly higher in the OSR group (3.4 days vs 1.5 days; P = .01). Surgical risk was significantly higher in the F-EVAR group as measured by Lee score ≥2 (OSR, 8.9 %; F-EVAR, 21%; P = .02) and ASA class 3 and class 4 (OSR, 32.8%; F-EVAR, 73.6%; P = .001), whereas 30-day postoperative mortality was not significantly different (OSR, 1.5%; F-EVAR, 0%; P = .394). The 5-year survival was not significantly different in the two groups (OSR, 82.1%; F-EVAR, 69.2%).
In this study, despite a higher surgical risk by Lee score and higher ASA class in the group of patients treated by F-EVAR, postoperative mortality was not significantly different between these groups. In our opinion, F-EVAR and OSR of JRA are complementary.
本研究旨在比较腔内修复术（F-EVAR）和开放手术修复（OSR）治疗解剖分类肾周腹主动脉瘤（JRAs）的手术风险及早期和晚期死亡率，并验证一种 JRA 修复的机构算法。
我们回顾性纳入 2005 年 1 月至 2015 年 12 月在我们中心接受治疗的所有 JRAs 患者，这些患者被分为三个解剖类别，不包括肾上动脉瘤。Lee 评分和美国麻醉师协会（ASA）分级评估术前手术风险。我们比较了 F-EVAR 治疗组和 OSR 治疗组的临床和影像学参数。主要研究终点为 30 天死亡率。我们还比较了 5 年生存率。
2005 年至 2015 年，共有 191 例患者分为两组，一组接受 OSR（n=134；平均年龄 69 岁），另一组接受 F-EVAR（n=57；平均年龄 74 岁）。F-EVAR 组患者年龄明显较大（P=0.001）。OSR 组患者 ICU 住院时间明显较长（3.4 天比 1.5 天；P=0.01）。F-EVAR 组 Lee 评分≥2（OSR 为 8.9%；F-EVAR 为 21%；P=0.02）和 ASA 3 级和 4 级（OSR 为 32.8%；F-EVAR 为 73.6%；P=0.001）的手术风险明显更高，而 30 天术后死亡率无显著差异（OSR 为 1.5%；F-EVAR 为 0%；P=0.394）。两组 5 年生存率无显著差异（OSR 为 82.1%；F-EVAR 为 69.2%）。
在这项研究中，尽管 F-EVAR 治疗组患者的 Lee 评分和 ASA 分级较高，但手术风险较高，但两组患者的术后死亡率无显著差异。在我们看来，F-EVAR 和 OSR 治疗 JRAs 是互补的。
