Elsayed Nadin, Alhakim Rami, Al Nouri Omar, Baril Donald, Weaver Fred, Malas Mahmoud B
Division of Vascular and Endovascular Surgery, University of California, San Diego, La Jolla, CA.
Division of Vascular Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
J Vasc Surg. 2023 Jan;77(1):89-96. doi: 10.1016/j.jvs.2022.07.172. Epub 2022 Aug 4.
The use of endovascular abdominal aortic aneurysm repair (EVAR) has superseded that of open aneurysm repair (OAR) as the procedure of choice for abdominal aortic aneurysm repair. However, significant rates of late reintervention and aneurysm rupture have been reported after EVAR, resulting in the need for conversion to OAR (C-OAR). To assess the relative effects of C-OAR on patients, we compared the outcomes of these patients to those of patients who had undergone P-OAR.
The data from all patients who had undergone C-OAR and P-OAR in the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database from 2003 to 2018 were queried. Multivariable logistic regression and Kaplan-Meier survival and Cox proportional hazard regression analyses were used to assess the perioperative long-term outcomes.
A total of 4763 patients were included (91.4%, P-OAR; 8.6%, C-OAR). C-OAR was associated with a significant increase in the odds of perioperative mortality (odds ratio, 1.7; 95% confidence interval [CI], 1.1-2.7; P = .027) and renal complications (odds ratio, 1.5; 95% CI, 1.1-2; P = .004) vs P-OAR. At 5 years, conversion was associated with a higher risk of mortality (hazard ratio [HR], 1.5; 95% CI, 1.3-1.9; P < .001), aneurysmal rupture (HR, 1.9; 95% CI, 1.2-3.1; P = .007), and reintervention (HR, 1.4; 95% CI, 1.05-1.97; P = .022) compared with P-OAR. These results also persisted at 10 years, with conversion associated with a higher risk of mortality (HR, 1.5; 95% CI, 1.2-1.8; P < .001), rupture (HR, 1.8; 95% CI, 1.1-2.8; P = .018), and reintervention (HR, 1.5; 95% CI, 1.1-2.1; P = .010).
The results from the present study have demonstrated that C-OAR is associated with a significantly higher risk of perioperative morbidity and mortality compared with P-OAR. We found a significant increase in mortality, aneurysm rupture, and reintervention at 5 and 10 years of follow-up.
血管内腹主动脉瘤修复术（EVAR）已取代开放性动脉瘤修复术（OAR），成为腹主动脉瘤修复的首选术式。然而，有报道称EVAR术后晚期再次干预和动脉瘤破裂的发生率较高，因此需要转为OAR（C-OAR）。为评估C-OAR对患者的相对影响，我们将这些患者的结局与接受原发性OAR（P-OAR）的患者进行了比较。
查询了2003年至2018年血管质量倡议血管植入监测和介入结局网络数据库中所有接受C-OAR和P-OAR的患者的数据。采用多变量逻辑回归、Kaplan-Meier生存分析和Cox比例风险回归分析来评估围手术期长期结局。
共纳入4763例患者（91.4%为P-OAR；8.6%为C-OAR）。与P-OAR相比，C-OAR与围手术期死亡率（比值比，1.7；95%置信区间[CI]，1.1-2.7；P = 0.027）和肾脏并发症（比值比，1.5；95% CI，1.1-2；P = 0.004）的比值显著增加相关。在5年时，与P-OAR相比，转为C-OAR与更高的死亡风险（风险比[HR]，1.5；95% CI，1.3-1.9；P < 0.001）、动脉瘤破裂（HR，1.9；95% CI，1.2-3.1；P = 0.007）和再次干预（HR，1.4；95% CI，1.05-1.97；P = 0.022）相关。这些结果在10年时也依然存在，转为C-OAR与更高的死亡风险（HR，1.5；95% CI，1.2-1.8；P < 0.001）、破裂（HR，1.8；95% CI，1.1-2.8；P = 0.018）和再次干预（HR，1.5；95% CI，1.1-2.1；P = 0.010）相关。
本研究结果表明，与P-OAR相比，C-OAR与围手术期发病率和死亡率的显著更高风险相关。我们发现在随访5年和10年时，死亡率、动脉瘤破裂和再次干预显著增加。
