Li W H, Li W, Zhang X M, Li Q L, Jiao Y, Zhang T, Jiang J J, Zhang X M
Department of Vascular Surgery, Peking University People's Hospital, Beijing 100044, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2022 Feb 18;54(1):177-181. doi: 10.19723/j.issn.1671-167X.2022.01.028.
Thoracoabdominal aortic aneurysm is one of the most challenging aortic diseases. Open surgical repair remains constrained with considerable perioperative morbidity and mortality. The emergence of a hybrid approach utilizing visceral debranching with endovascular aneurysm repair has brought an alternative for high-risk patients. This study aimed to compare the short- and long-term outcomes between hybrid and open repairs in the treatment of thoracoabdominal aortic aneurysms.
In this retrospectively observational study, patients with thoracoabdominal aortic aneurysm treated in a single center between January 2008 and December 2019 were reviewed, of whom 11 patients with hybrid repair, and 18 patients with open repair were identified. Demographic characteristic, operative data, perioperative morbidity and mortality, freedom from reintervention, and long-term survival were compared between the two groups.
In the hybrid repair group, the patients with dissection aneurysm, preoperative combined renal insufficiency, and American Society of Anesthesiologists (ASA) score of 3 or more were significantly overwhelming than in the open repair group. The operation time of debranching hybrid repair was (445±85) min, and the intraoperative blood loss was (955±599) mL. There were 2 cases of complications in the early 30 days after surgery, without paraplegia, and 1 case died. The 30-day complication rate was 18.2%, and the 30-day mortality was 9.1%. The operation time of the patients with open repair was (560±245) min, and the intraoperative blood loss was (6 100±4 536) mL. Twelve patients had complications in the early 30 days after surgery, including 1 paraplegia and 4 deaths within 30 days. The 30-day complication rate was 66.7%, and the 30-day mortality was 22.2%. The bleeding volume in hybrid repair was significantly reduced compared with open repair ( < 0.001). Besides, the incidence of 30-day complications in hybrid surgery was significantly reduced (=0.011). During the follow-up period, there were 4 reinterventions and 3 deaths in hybrid repair group. The 1-year, 5-year, and 10-year all-cause survival rates were 72%, 54%, and 29%, respectively. In open repair group, reintervention was performed in 1 case and 5 cases died, and the 1-year, 5-year, and 10-year all-cause survival rates were 81%, 71%, and 35%, respectively. There was no significant difference between hybrid repair and open repair in all-cause survival and aneurysm-specific survival.
Hybrid approach utilizing visceral debranching with endovascular aneurysm repair is a safe and effective surgical method for high-risk patients with thoracoabdominal aortic aneurysms. The incidence of early postoperative complications and mortality is significantly reduced compared with traditional surgery, but the efficacy in the medium and long term still needs to be improved.
胸腹主动脉瘤是最具挑战性的主动脉疾病之一。开放手术修复仍受围手术期较高发病率和死亡率的限制。采用内脏去分支技术结合血管腔内动脉瘤修复术的杂交手术方法为高危患者带来了一种替代方案。本研究旨在比较杂交手术和开放手术治疗胸腹主动脉瘤的短期和长期疗效。
在这项回顾性观察研究中，对2008年1月至2019年12月在单一中心接受治疗的胸腹主动脉瘤患者进行了回顾，其中11例接受杂交修复，18例接受开放修复。比较两组患者的人口统计学特征、手术数据、围手术期发病率和死亡率、再次干预的自由度以及长期生存率。
杂交修复组中，夹层动脉瘤、术前合并肾功能不全以及美国麻醉医师协会（ASA）评分≥3分的患者明显多于开放修复组。去分支杂交修复的手术时间为（445±85）分钟，术中出血量为（955±599）毫升。术后早期30天内有2例发生并发症，无截瘫，1例死亡。30天并发症发生率为18.2%，30天死亡率为9.1%。开放修复患者的手术时间为（560±245）分钟，术中出血量为（6100±4536）毫升。12例患者在术后早期30天内发生并发症，包括1例截瘫和30天内4例死亡。30天并发症发生率为66.7%，30天死亡率为22.2%。与开放修复相比，杂交修复的出血量显著减少（P<0.001）。此外，杂交手术30天并发症的发生率显著降低（P=0.011）。随访期间，杂交修复组有4例再次干预，3例死亡。1年、5年和10年全因生存率分别为72%、54%和29%。开放修复组有1例进行了再次干预，5例死亡，1年、5年和10年全因生存率分别为81%、71%和35%。杂交修复和开放修复在全因生存率和动脉瘤特异性生存率方面无显著差异。
采用内脏去分支技术结合血管腔内动脉瘤修复术的杂交手术方法是治疗高危胸腹主动脉瘤患者的一种安全有效的手术方法。与传统手术相比，术后早期并发症发生率和死亡率显著降低，但中长期疗效仍有待提高。
