von Meijenfeldt Gerdine C I, Alberga Anna J, Balm Ron, Vahl Anco C, Verhagen Hence J M, Blankensteijn Jan D, Zeebregts Clark J, van der Laan Maarten J
Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
J Vasc Surg. 2022 Jan;75(1):81-89.e5. doi: 10.1016/j.jvs.2021.06.031. Epub 2021 Jun 29.
Juxtarenal abdominal aortic aneurysms (JRAAAs) can be treated either with open surgical repair (OSR) including suprarenal clamping or by complex endovascular aneurysm repair (cEVAR). In this study, we present the comparison between the short-term mortality and complications of the elective JRAAA treatment modalities from a national database reflecting daily practice in The Netherlands.
All patients undergoing elective JRAAA open repair or cEVAR (fenestrated EVAR or chimney EVAR) between January 2016 and December 2018 registered in the Dutch Surgical Aneurysm Audit (DSAA) were eligible for inclusion. Descriptive perioperative variables and outcomes were compared between patients treated with open surgery or endovascularly. Adjusted odds ratios for short-term outcomes were calculated by logistic regression analysis.
In all, 455 primary treated patients with JRAAAs could be included (258 OSR, 197 cEVAR). Younger patients and female patients were treated more often with OSR vs cEVAR (72 ± 6.1 vs 76 ± 6.0; P < .001 and 22% vs 15%; P = .047, respectively). Patients treated with OSR had significantly more major and minor complications as well as a higher chance of early mortality (OSR vs cEVAR, 45% vs 21%; P < .001; 34% vs 23%; P = .011; and 6.6% vs 2.5%; P = .046, respectively). After logistic regression with adjustment for confounders, patients who were treated with OSR showed an odds ratio of 3.64 (95% confidence interval [CI], 2.25-5.89; P < .001) for major complications compared with patients treated with cEVAR, and for minor complications, the odds ratios were 2.17 (95% CI, 1.34-3.53; P = .002) higher. For early mortality, the odds ratios were 3.79 (95% CI, 1.26-11.34; P = .017) higher after OSR compared with cEVAR.
In this study, after primary elective OSR for JRAAA, the odds for major complications, minor complications, and short-term mortality were significantly higher compared with cEVAR.
肾旁腹主动脉瘤（JRAAA）的治疗方法包括开放手术修复（OSR），即肾上钳夹术，或复杂的血管腔内动脉瘤修复术（cEVAR）。在本研究中，我们从反映荷兰日常医疗实践的国家数据库中，对选择性JRAAA治疗方式的短期死亡率和并发症进行了比较。
纳入2016年1月至2018年12月期间在荷兰外科动脉瘤审计（DSAA）中登记的所有接受选择性JRAAA开放修复或cEVAR（开窗型EVAR或烟囱型EVAR）治疗的患者。比较开放手术或血管腔内治疗患者的围手术期描述性变量和结果。通过逻辑回归分析计算短期结果的调整比值比。
总共纳入455例接受初次治疗的JRAAA患者（258例接受OSR，197例接受cEVAR）。与cEVAR相比，接受OSR治疗的年轻患者和女性患者更多（分别为72±6.1岁对76±6.0岁；P<.001和22%对15%；P=.047）。接受OSR治疗的患者发生的严重和轻微并发症明显更多，早期死亡几率也更高（OSR与cEVAR相比，分别为45%对21%；P<.001；34%对23%；P=.011；6.6%对2.5%；P=.046）。在对混杂因素进行调整的逻辑回归分析后，与接受cEVAR治疗的患者相比，接受OSR治疗的患者发生严重并发症的比值比为3.64（95%置信区间[CI]，2.25-5.89；P<.001），发生轻微并发症的比值比高2.17（95%CI，1.34-3.53；P=.002）。对于早期死亡，与cEVAR相比，OSR后的比值比高3.79（95%CI，1.26-11.34；P=.017）。
在本研究中，JRAAA初次选择性OSR后，与cEVAR相比，发生严重并发症、轻微并发症和短期死亡的几率显著更高。
