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门诊经皮腔内血管腹主动脉瘤修复术:单中心经验。

Outpatient Percutaneous Endovascular Abdominal Aortic Aneurysm Repair: A Single-Center Experience.

机构信息

Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Institute for Radiological Research, Chang Gung University, No.5, Fusing St., Gueishan Dist., Taoyuan, 33305, Taiwan.

Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.

出版信息

J Vasc Interv Radiol. 2021 Mar;32(3):466-471. doi: 10.1016/j.jvir.2020.11.012. Epub 2020 Dec 14.

Abstract

PURPOSE

To evaluate the safety of outpatient percutaneous endovascular abdominal aortic repair (PEVAR) versus inpatient PEVAR without or with adjunct procedures.

MATERIALS AND METHODS

Between January 2012 and June 2019, a cohort of 359 patients comprising 168 (46.8%) outpatients and 191 (53.2%) inpatients who had undergone PEVAR were enrolled. All the patients were asymptomatic but had indications for endovascular aortic repair, ie, fit for intravenous anesthesia and anatomically feasible with standard devices. Patient sex, age, comorbidities, smoking status, type of anesthesia, adjunct procedures, type of graft device, operative times, mortality, complications, and readmissions were analyzed.

RESULTS

Median follow-up period was 16.5 months (interquartile range, 9-31 months). Except for a higher percentage of tobacco use (42.6% vs 28.8%; P = .04), dyslipidemia (39.7% vs 19.2%; P < .01), and use of local anesthesia (99.4% vs 82.2%; P < .01) in the outpatients, there was no significant difference in the type of graft and adjunct procedures used. No outpatient mortality occurred. There was no difference in the number, severity, and onset of complications (all P > .05). Outpatient unexpected same-day admission, 30-day readmission, and emergency department visit rates were 4.8%, 2.4% (P = .13), and 10% (P < .01), respectively. Operative times for outpatient PEVAR without adjunct procedures were shorter (P < .01).

CONCLUSIONS

Outpatient PEVAR can be performed with a safety profile similar to that of inpatient PEVAR. The unexpected same-day admission, 30-day readmission, and emergency department visit rates were low. The outpatient PEVARs without adjunct procedures took less time.

摘要

目的

评估门诊经皮血管内腹主动脉修复术(PEVAR)与非住院或有辅助治疗的住院 PEVAR 的安全性。

材料和方法

2012 年 1 月至 2019 年 6 月,纳入了一组 359 名患者,其中 168 名(46.8%)为门诊患者,191 名(53.2%)为住院患者,这些患者均为无症状患者,但有血管内主动脉修复指征,即适合静脉麻醉,解剖结构适合使用标准设备。分析了患者的性别、年龄、合并症、吸烟状况、麻醉类型、辅助治疗、移植物装置类型、手术时间、死亡率、并发症和再入院情况。

结果

中位随访时间为 16.5 个月(四分位距,9-31 个月)。除门诊患者中吸烟率(42.6%比 28.8%;P =.04)、血脂异常(39.7%比 19.2%;P <.01)和局部麻醉使用率(99.4%比 82.2%;P <.01)较高外,两组在移植物和辅助治疗的使用类型上无显著差异。门诊患者无死亡病例。两组并发症的数量、严重程度和发生时间无差异(均 P >.05)。门诊患者非预期当日再入院、30 天再入院和急诊就诊率分别为 4.8%、2.4%(P =.13)和 10%(P <.01)。无辅助治疗的门诊 PEVAR 手术时间更短(P <.01)。

结论

门诊 PEVAR 可安全进行,其安全性与住院 PEVAR 相似。非预期当日再入院、30 天再入院和急诊就诊率较低。无辅助治疗的门诊 PEVAR 手术时间更短。

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