European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, Germany.
European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, Germany.
Eur J Vasc Endovasc Surg. 2022 Apr;63(4):578-586. doi: 10.1016/j.ejvs.2022.02.003. Epub 2022 Feb 9.
This study reports on open TAAA repair comparing short and long term patient outcome according to the type of repair defined by the Crawford classification and elective vs. emergency repair. Endpoints were death, acute kidney injury (AKI), sepsis, spinal cord ischaemia (SCI), and re-intervention rate.
This was a retrospective study reporting the outcomes of 255 patients (between 2006 and 2019), designed according to the STROBE criteria.
The TAAA distribution was type I 25%, type II 26%, type III 23%, type IV 18%, and type V 7%. Fifty-one (20%) patients had an emergency procedure. Of all the patients, 51% had a history of aortic surgery, 58% suffered from post-dissection TAAA, and 26% had connective tissue disease. The in hospital mortality rate among electively treated patients was 16% (n = 33) vs. 35% (n = 18) in the emergency subgroup; the total mortality rate was 20% (n = 51). The adjusted odds ratio for in hospital death following emergency repair compared with elective repair was 2.52 (95% confidence interval [CI] 1.15 - 5.48). Temporary renal replacement therapy because of AKI was required in 29% (n = 74) of all patients, sepsis from different cause was observed in 37% (n = 94), and SCI in 7% (n = 18, 10 patients suffering from paraplegia and eight from paraparesis). The mean follow up time was 3.0 years (median 1.5, range 0 - 12.8 years). Aortic related re-intervention was required in 2.8%. The total mortality rate during follow up was 22.5% (n = 46); 5.3% (n = 11) of all patients died because of aortic related events.
Open TAAA repair is associated with an important morbidity and mortality rate, yet the incidence of spinal cord ischaemia may be favourably low if a neuromonitoring protocol is applied. The aortic related re-intervention and aortic related mortality rate during follow up are low.
本研究报告了根据 Crawford 分类定义的修复类型以及择期与急诊修复对开放 TAAA 修复的短期和长期患者结局进行比较。终点为死亡、急性肾损伤 (AKI)、败血症、脊髓缺血 (SCI) 和再介入率。
这是一项回顾性研究,根据 STROBE 标准报告了 255 名患者(2006 年至 2019 年)的结局。
TAAA 分布为 I 型 25%、II 型 26%、III 型 23%、IV 型 18%和 V 型 7%。51 例(20%)患者行急诊手术。所有患者中,51%有主动脉手术史,58%有夹层后 TAAA,26%有结缔组织疾病。择期治疗患者的院内死亡率为 16%(n=33),急诊亚组为 35%(n=18);总死亡率为 20%(n=51)。与择期修复相比,急诊修复后院内死亡的调整优势比为 2.52(95%置信区间[CI]1.15-5.48)。由于 AKI 需要临时肾脏替代治疗的患者占所有患者的 29%(n=74),不同原因导致的败血症为 37%(n=94),SCI 为 7%(n=18,10 例为截瘫,8 例为截瘫)。平均随访时间为 3.0 年(中位数 1.5 年,范围 0-12.8 年)。需要再次干预主动脉相关病变的患者占 2.8%。随访期间的总死亡率为 22.5%(n=46);所有患者中有 5.3%(n=11)死于主动脉相关事件。
开放 TAAA 修复与较高的发病率和死亡率相关,但如果应用神经监测方案,脊髓缺血的发生率可能较低。随访期间的主动脉相关再介入和主动脉相关死亡率较低。