腹主动脉瘤腔内修复术的并发症：一项单中心回顾性研究。
Complications of endo-vascular aortic repair for abdominal aortic aneurysm: A retrospective single-centre experience.
作者信息
Al-Zoubi Nabil A, Al-Shawwa Zuhair
机构信息
Department of Surgery, Department of Vascular, Jordan University of Science and Technology, Irbid, Jordan.
出版信息
Ann Med Surg (Lond). 2021 Mar 23;64:102219. doi: 10.1016/j.amsu.2021.102219. eCollection 2021 Apr.
BACKGROUND
Endovascular aortic repair (EVAR) is obviously less invasive than open aortic repair (OAR) for the treatment of infra-renal abdominal aortic aneurysm (AAA). However, it is not free of complications which can potentially result in severe morbidity or even mortality. The purpose of this study was to share our single-center experience with stent-graft related and systemic complications associated with EVAR.
METHODS
Patients with infra-renal AAA treated by elective and emergency EVAR between March 2014 and November 2020 were retrospectively identified. Demographic data, risk factors, American Society of Anesthesiologists (ASA) score, systemic complications, stent-graft related complications, surgical site complications, 30-day mortality, late EVAR related mortality, estimated blood loss, intensive care unit (ICU) length of stay (LOS), hospital LOS and follow-up durations were collected and analyzed.
RESULTS
A total of 43 patients underwent EVAR during the period of study. There were 42 males (97.7%) and 1 female (2.3%). The mean age was 68.8 ± 6.2 years. Elective EVAR was performed in 36 (83.7%) and emergency EVAR in 7 (16.3%). Technical success was achieved in 42 patients (100%) with no conversion to OAR. Stent-graft related complications were (21.0%) endoleaks, (2.3%) graft limb occlusion, (0%) graft infection, and (2.3%) rupture-EVAR. Systemic complications were (2.3%) myocardial infarction (MI), (2.3%) stroke, (2.3%) spinal cord injury (SCI), (2.3%) respiratory failure, (19.0%) wound complications, and (2.3%) acute lower limb ischemia (ALI). The 30-day mortality was (2.3%) due to perioperative MI and the late graft related mortality was (2.3%) due to rupture-EVAR.
CONCLUSION
EVAR showed a high technical success rate with no conversion to OAR. The most common complications were type II and type I endoleaks followed by graft limb occlusion. The 30-day mortality was 2.3% due to perioperative MI. Only one late stent-graft related mortality was registered due to rupture-EVAR.
背景
对于治疗肾下腹主动脉瘤（AAA），血管内主动脉修复术（EVAR）明显比开放主动脉修复术（OAR）侵入性小。然而，它并非没有并发症，这些并发症可能导致严重的发病甚至死亡。本研究的目的是分享我们单中心关于与EVAR相关的支架移植物及全身并发症的经验。
方法
回顾性确定2014年3月至2020年11月期间接受择期和急诊EVAR治疗的肾下腹主动脉瘤患者。收集并分析人口统计学数据、危险因素、美国麻醉医师协会（ASA）评分、全身并发症、支架移植物相关并发症、手术部位并发症、30天死亡率、EVAR晚期相关死亡率、估计失血量、重症监护病房（ICU）住院时间（LOS）、住院LOS和随访时间。
结果
在研究期间共有43例患者接受了EVAR。其中男性42例（97.7%），女性1例（2.3%）。平均年龄为68.8±6.2岁。36例（83.7%）进行了择期EVAR，7例（16.3%）进行了急诊EVAR。42例患者（100%）技术成功，无一例转为OAR。支架移植物相关并发症包括内漏（21.0%）、移植物肢体闭塞（2.3%）、移植物感染（0%）和EVAR破裂（2.3%）。全身并发症包括心肌梗死（MI，2.3%）、中风（2.3%）、脊髓损伤（SCI，2.3%）、呼吸衰竭（2.3%）、伤口并发症（19.0%）和急性下肢缺血（ALI，2.3%）。30天死亡率因围手术期MI为2.3%，晚期移植物相关死亡率因EVAR破裂为2.3%。
结论
EVAR显示出较高的技术成功率，无一例转为OAR。最常见的并发症是II型和I型内漏，其次是移植物肢体闭塞。30天死亡率因围手术期MI为2.3%。仅记录到1例因EVAR破裂导致的晚期支架移植物相关死亡。
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