Department of Surgery, County Hospital, Kalmar, Sweden; Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Centre for Quality Registries South/Karlskrona, Blekinge Hospital, Karlskrona, Sweden; Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
J Vasc Surg. 2020 Aug;72(2):508-517.e11. doi: 10.1016/j.jvs.2019.11.060. Epub 2020 Mar 3.
The objective of this study was to clarify whether the findings of the randomized studies of repair method (open aortic repair [OAR] vs endovascular aneurysm repair [EVAR]) concerning short-term and midterm survival for ruptured abdominal aortic aneurysms (RAAAs) could be confirmed in a contemporary, nationwide, and unselected population.
This cohort study is based on prospectively collected data from Swedvasc, a nationwide vascular registry, including all 29 hospitals performing surgery for RAAA in Sweden (3 district, 19 county, and 7 university hospitals) during 2013 to 2015. All 702 patients operated on for RAAA during this time were included. Open surgery and endovascular repair, analyzed on the basis of individual patient repair (OAR vs EVAR) and hospital repair practice (OAR-only vs OAR/EVAR), were compared for short-term and midterm adjusted survival (0-90 days and 3 months-3 years).
Endovascular repair was used for 37% (260/702) of the aneurysms. The adjusted hazard ratio after OAR was 1.30 (0.95-1.77; P = .098; n = 702) for 0 to 90 days and 0.63 (0.43-0.93; P = .021; n = 491) for 3 months to 3 years of follow-up compared with EVAR. The adjusted hazard ratio for a practice of OAR-only was 0.73 (0.54-1.00; P = .047; n = 702) for 0 to 90 days and 0.68 (0.45-1.05; P = .080; n = 491) for 3 months to 3 years of follow-up compared with a practice of OAR/EVAR. No interaction between repair practice and short-term survival could be shown for either sex or age.
An OAR/EVAR practice for RAAA is not superior to an OAR-only practice with respect to survival at short-term or midterm follow-up. The results are even compatible with an advantage of OAR-only practice vs OAR/EVAR practice for both follow-up periods. There is no extra benefit for either female or elderly patients with an OAR/EVAR practice.
本研究旨在明确修复方法（开放式主动脉修复[OAR]与血管内动脉瘤修复[EVAR]）随机研究关于破裂性腹主动脉瘤（RAAA）的短期和中期生存结果是否可以在当代、全国范围内和未经选择的人群中得到证实。
本队列研究基于瑞典全国血管登记处 Swedvasc 前瞻性收集的数据，纳入了 2013 年至 2015 年期间瑞典 29 家医院治疗 RAAA 的所有 702 例患者。所有接受 RAAA 手术的患者均被纳入研究。基于个体患者的修复（OAR 与 EVAR）和医院的修复实践（仅 OAR 与 OAR/EVAR），对开放手术和血管内修复进行了分析，比较了短期和中期校正后的生存率（0-90 天和 3 个月-3 年）。
血管内修复用于 702 例动脉瘤中的 37%（260 例）。与 EVAR 相比，OAR 后 0 至 90 天的调整后危险比为 1.30（95%置信区间：0.95-1.77；P=0.098；n=702），3 个月至 3 年的调整后危险比为 0.63（0.43-0.93；P=0.021；n=491）。仅 OAR 实践的调整后危险比为 0.73（95%置信区间：0.54-1.00；P=0.047；n=702），3 个月至 3 年的调整后危险比为 0.68（0.45-1.05；P=0.080；n=491）。与 OAR/EVAR 实践相比，OAR 实践在短期和中期随访中并不优于仅 OAR 实践。对于两种随访期，甚至都可以看到仅 OAR 实践优于 OAR/EVAR 实践。对于女性或老年患者，OAR/EVAR 实践并没有额外的获益。
