Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian-Columbia University Medical Center, New York, NY.
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
J Vasc Surg. 2021 Aug;74(2):425-432.e3. doi: 10.1016/j.jvs.2020.12.109. Epub 2021 Feb 4.
Previous studies evaluating the association between abdominal aortic aneurysm (AAA) size with postoperative outcomes after open repairs seldom accounted for renal or visceral artery involvement, proximal clamp site, intraoperative renal ischemia time, and hospital volume. This study examined the association between aneurysm size with outcomes after open repairs.
We identified patients who underwent open repairs of infrarenal versus juxtarenal nonruptured AAAs, defined by proximal clamp site, in the 2004-2019 Vascular Quality Initiative. Outcomes included 30-day mortality, postoperative complications, failure to rescue, and 1-year mortality. Multivariable logistic regressions adjusted for patient characteristics, operative factors, hospital volume, and hospital clustering.
We identified 8011 patients (54% infrarenal, 46% juxtarenal). The median aneurysm size did not differ between infrarenal versus juxtarenal aneurysms (5.7 cm vs 5.9 cm; P = .12). For infrarenal aneurysms, every 1-cm increase in size increase the adjusted odds ratio (OR) or hazard ratio (HR) of 30-day mortality by 18% (OR, 1.18; 95% CI, 1.06-1.31), failure to rescue by 20% (OR, 1.20; 95% CI, 1.06-1.34), 1-year mortality by 18% (HR, 1.18; 95% CI, 1.10-1.26), but not complications (OR, 1.03; 95% CI, 0.98-1.07). For juxtarenal aneurysm, larger aneurysm sizes were not associated with any outcome. Proximal clamp site, ischemia time, and volume were associated with outcomes.
The association between AAA size and outcomes matters less with renal and visceral artery aneurysmal involvement, having important implications for surgical decision-making, operative planning, and patient counseling.
先前评估腹主动脉瘤（AAA）大小与开放修复术后结局之间关系的研究很少考虑到肾或内脏动脉受累、近端夹闭部位、术中肾缺血时间和医院容量。本研究检查了 AAA 大小与开放修复术后结局之间的关系。
我们确定了在 2004 年至 2019 年血管质量倡议中，根据近端夹闭部位，接受肾下和肾周非破裂 AAA 开放修复的患者。结果包括 30 天死亡率、术后并发症、抢救失败和 1 年死亡率。多变量逻辑回归调整了患者特征、手术因素、医院容量和医院聚类。
我们确定了 8011 例患者（54%为肾下，46%为肾周）。肾下与肾周动脉瘤的中位动脉瘤大小无差异（5.7cm 与 5.9cm；P=0.12）。对于肾下动脉瘤，大小每增加 1cm，30 天死亡率的调整比值比（OR）或风险比（HR）增加 18%（OR，1.18；95%置信区间，1.06-1.31），抢救失败的风险增加 20%（OR，1.20；95%置信区间，1.06-1.34），1 年死亡率增加 18%（HR，1.18；95%置信区间，1.10-1.26），但不增加并发症（OR，1.03；95%置信区间，0.98-1.07）。对于肾周动脉瘤，较大的动脉瘤大小与任何结果均无关。近端夹闭部位、缺血时间和容量与结果相关。
AAA 大小与结局之间的关系在肾和内脏动脉动脉瘤受累时相关性较小，这对手术决策、手术计划和患者咨询具有重要意义。
