Liao Jane L, Wang S Keisin, Maijub John G, Gupta Alok K, Sawchuk Alan P, Motaganahalli Raghu L, Murphy Michael P, Fajardo Andres C
Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
Ann Vasc Surg. 2020 Oct;68:44-49. doi: 10.1016/j.avsg.2020.05.036. Epub 2020 May 29.
Inferior perioperative outcomes for women receiving major vascular surgery are well established in the literature in multiple arterial distributions. Therefore, this study was completed to determine the perioperative and durability results associated with women undergoing complex aortic reconstruction using the Zenith Fenestrated platform (ZFEN; Cook Medical, Bloomington, IN).
A retrospective review of a fenestrated endovascular aortic repair (FEVAR) database capturing all ZFENs performed at our institution between October 2012 and March 2019 was completed. Preoperative, intraoperative, perioperative, and follow-up outcomes were tabulated for females and compared with their male counterparts.
Within our study period, 136 total ZFEN procedures were performed; of which, 20 devices (14.7%) were implanted in women. Intraoperatively, we observed a higher rate of estimated blood loss (660.0 mL vs. 311.6 mL, P < 0.01) and resultant need for transfusion (1.4 vs. 0.3 units, P < 0.01) in women despite a similar frequency of brachial (5.0% vs. 7.8%, P > 0.99) and femoral artery cutdowns (55.0% vs. 49.1%, P = 0.81). Operative (295.7 min vs. 215.7 mins, P < 0.01) and fluoroscopy (84.3 vs. 58.7 min, P < 0.01) times were also significantly higher in females than those in their male counterparts. In the perioperative (30-day) period, we observed significantly longer length of stay (5.6 days vs. 3.3 days, P = 0.03) and continued need for transfusion (50% vs. 9.5%, P < 0.01) in women. Statistical trends favoring men were also noted with respect to all-cause mortality, reintervention, visceral stent thrombosis, renal failure, acute kidney injury, and respiratory failure. After a mean follow-up of nearly 2 years, we found no differences in late all-cause or aneurysm-related mortality, major adverse cardiovascular events, or need for reinterventions.
The implantation of ZFEN in females is significantly more difficult than that in their male counterparts and may result in increased perioperative, but not necessarily long-term, complications.
接受大血管手术的女性围手术期预后较差，这在多个动脉分布的文献中已得到充分证实。因此，本研究旨在确定使用Zenith开窗平台（ZFEN；库克医疗公司，印第安纳州布卢明顿）进行复杂主动脉重建的女性患者的围手术期及耐久性结果。
对2012年10月至2019年3月在我们机构进行的所有ZFEN手术的开窗血管内主动脉修复（FEVAR）数据库进行回顾性分析。将女性患者的术前、术中、围手术期和随访结果进行列表，并与男性患者进行比较。
在我们的研究期间，共进行了136例ZFEN手术；其中，20例（14.7%）装置植入女性患者体内。术中，尽管女性患者肱动脉切开（5.0%对7.8%，P>0.99）和股动脉切开（55.0%对49.1%，P=0.81）的频率相似，但我们观察到女性患者的估计失血量（660.0 mL对311.6 mL，P<0.01）和由此导致的输血需求（1.4单位对0.3单位，P<0.01）更高。女性患者的手术时间（295.7分钟对215.7分钟，P<0.01）和透视时间（84.3分钟对58.7分钟，P<0.01）也显著高于男性患者。在围手术期（30天），我们观察到女性患者的住院时间显著更长（5.6天对3.3天，P=0.03），并且持续有输血需求（50%对9.5%，P<0.01）。在全因死亡率、再次干预、内脏支架血栓形成、肾衰竭、急性肾损伤和呼吸衰竭方面，也观察到有利于男性的统计趋势。经过近2年的平均随访，我们发现晚期全因或动脉瘤相关死亡率、主要不良心血管事件或再次干预需求方面没有差异。
在女性患者中植入ZFEN比男性患者困难得多，可能会导致围手术期并发症增加，但不一定会导致长期并发症增加。
