择期开放和血管内主动脉瘤修复后的 5 年生存率。
Five-year survival after elective open and endovascular aortic aneurysm repair.
机构信息
Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia Department of Surgery, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
Medical Faculty, University of Tartu, Tartu, Estonia.
出版信息
Scand J Surg. 2022 Jan-Mar;111(1):14574969211048707. doi: 10.1177/14574969211048707. Epub 2021 Nov 14.
BACKGROUND AND OBJECTIVE
Current evidence suggests short-term survival benefit from endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) in elective abdominal aortic aneurysm (AAA) procedures, but this benefit is lost during long-term follow-up. The aim of this study was to compare short- and mid-term all-cause mortality in patients with non-ruptured aneurysm treated by OSR and EVAR; and to assess the rate of complications and reinterventions, as well as to evaluate their impact on survival.
METHODS
The medical records of the non-ruptured AAA patients undergoing OSR or EVAR between 1 January 2011 and 31 December 2019 at Tartu University Hospital, Estonia, were retrospectively reviewed. We gathered survival data from the national registry (mean follow-up period was 3.7 ± 2.3 years).
RESULTS
A total of 225 non-ruptured AAA patients were treated operatively out of whom 95 (42.2%) were EVAR and 130 (57.8%) were OSR procedures. The difference in estimated all-cause mortality between the OSR and EVAR groups at day 30 was statistically irrelevant (2.3% vs 0%; p = 0.140), but OSR patients showed statistically significantly higher 5 year survival compared with EVAR patients (75.3% vs 50.0%, p = 0.002). Complication and reintervention rates for the EVAR and OSR groups did not differ statistically (26.3% vs 16.9%, p = 0.122; 10.5% vs 11.5%, p = 0.981, respectively). Multivariate analysis revealed that greater aneurysm diameter (p = 0.012), EVAR procedure (p = 0.016), male gender (p = 0.023), and cerebrovascular diseases (p = 0.028) were independently positively associated with 5-year mortality.
CONCLUSIONS
Thirty-day mortality, and complication and reintervention rates for EVAR and OSR after elective AAA repair were similar. Although the EVAR procedure is an independent risk factor for 5-year mortality, higher age and greater proportion of comorbidities among EVAR patients may influence not only the choice of treatment modality, but also prognosis.
背景与目的
目前的证据表明，在择期腹主动脉瘤（AAA）手术中，血管内动脉瘤修复术（EVAR）与开放手术修复术（OSR）相比具有短期生存获益，但这种获益在长期随访中丧失。本研究旨在比较非破裂性AAA 患者接受 OSR 和 EVAR 治疗的短期和中期全因死亡率；评估并发症和再干预的发生率，并评估其对生存的影响。
方法
回顾性分析 2011 年 1 月 1 日至 2019 年 12 月 31 日期间在爱沙尼亚塔尔图大学医院接受 OSR 或 EVAR 治疗的非破裂性 AAA 患者的病历。我们从国家登记处收集了生存数据（平均随访时间为 3.7±2.3 年）。
结果
共有 225 例非破裂性 AAA 患者接受了手术治疗，其中 95 例（42.2%）接受了 EVAR，130 例（57.8%）接受了 OSR 手术。30 天时 OSR 组和 EVAR 组全因死亡率的差异无统计学意义（2.3%比 0%；p=0.140），但 OSR 组患者的 5 年生存率明显高于 EVAR 组（75.3%比 50.0%，p=0.002）。EVAR 组和 OSR 组的并发症和再干预率无统计学差异（26.3%比 16.9%，p=0.122；10.5%比 11.5%，p=0.981）。多变量分析显示，更大的动脉瘤直径（p=0.012）、EVAR 手术（p=0.016）、男性（p=0.023）和脑血管疾病（p=0.028）是 5 年死亡率的独立正相关因素。
结论
择期 AAA 修复术后 EVAR 和 OSR 的 30 天死亡率、并发症和再干预率相似。尽管 EVAR 手术是 5 年死亡率的独立危险因素，但 EVAR 患者年龄较大且合并症比例较高，这不仅可能影响治疗方式的选择，而且可能影响预后。
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