Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China.
Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, Fujian 350001, China.
J Interv Cardiol. 2022 Aug 22;2022:6550759. doi: 10.1155/2022/6550759. eCollection 2022.
To compare the efficacy of the percutaneous presuture technique (PPST) and the femoral artery incision technique (FAIT) under local anesthesia in the treatment of endovascular aortic repair (EVAR) for patients with uncomplicated type B aortic dissection (uTBAD).
Two hundred and ninety-five patients diagnosed with uTBAD who underwent EVAR under local anesthesia from June 2017 to December 2021 were consecutively and randomly selected for retrospective analysis. The PPST was performed in 178 cases and the FAIT was performed in 117 cases. The clinical characteristics and surgical and postoperative data from the two groups were analyzed.
There were no significant differences in clinical characteristics between the two groups ( > 0.05). The operative time of the PPST group was significantly shorter than that of the FAIT group (46 (33, 58) versus 72 (67.5, 78.0) minutes, < 0.001), as was the operative approach procedure time (6 (4.5, 9.0) versus 38 (36.5, 43.5) minutes, < 0.001), and length of postoperative hospital stay (5.19 ± 2.26 versus 8.33 ± 3.76 days, < 0.001). There were fewer postoperative approach-related procedural complications in the PPST group than in the FAIT group (2 versus 12, < 0.001); similarly, the average frequency of postoperative wound disinfection was significantly lower in the PPST group (1.08 ± 0.39 versus 3.31 ± 0.91 times, < 0.05). Obesity was identified as an independent risk factor for postoperative approach-related procedural complications (OR, 22.26; 95% CI, 4.74-104.49; < 0.001).
The PPST has comparable safety and efficacy to the FAIT in EVAR under local anesthesia. It can shorten the length of hospital stay, reduce operation time, lower the risk of wound-related complications, reduce the frequency of postoperative wound disinfection, and hasten postoperative recovery. It can therefore be used as a first-line surgical technique in EVAR of uTBAD under local anesthesia, especially in obese patients.
比较经皮预置缝合技术（PPST）和股动脉切开技术（FAIT）在局部麻醉下治疗单纯型 B 型主动脉夹层（uTBAD）患者血管内修复（EVAR）的疗效。
连续随机选取 2017 年 6 月至 2021 年 12 月 295 例接受局部麻醉下 EVAR 治疗的 uTBAD 患者进行回顾性分析。其中 178 例行 PPST，117 例行 FAIT。分析两组患者的临床特征、手术及术后资料。
两组患者的临床特征无显著差异（>0.05）。PPST 组手术时间明显短于 FAIT 组（46（33，58）与 72（67.5，78.0）min，<0.001），手术入路时间也明显短于 FAIT 组（6（4.5，9.0）与 38（36.5，43.5）min，<0.001），术后住院时间也明显短于 FAIT 组（5.19±2.26 与 8.33±3.76d，<0.001）。PPST 组术后入路相关手术并发症少于 FAIT 组（2 例与 12 例，<0.001）；同样，PPST 组术后伤口消毒次数也明显低于 FAIT 组（1.08±0.39 与 3.31±0.91 次，<0.05）。肥胖被确定为术后入路相关手术并发症的独立危险因素（OR：22.26；95%CI：4.74-104.49；<0.001）。
PPST 在局部麻醉下 EVAR 中的安全性和疗效与 FAIT 相当。它可以缩短住院时间，减少手术时间，降低伤口相关并发症的风险，减少术后伤口消毒次数，加快术后恢复。因此，它可以作为局部麻醉下 uTBAD EVAR 的一线手术技术，特别是在肥胖患者中。
