Tay Shirli, Zaghloul Mohamed S, Shafqat Mehreen, Yang Chao, Desai Kshitij A, De Silva Gayan, Sanchez Luis A, Zayed Mohamed A
Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States.
Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Surg. 2022 Oct 21;9:1040929. doi: 10.3389/fsurg.2022.1040929. eCollection 2022.
The PEVAR Trial demonstrated that compared to open femoral exposure, elective percutaneous endovascular AAA repair (ePEVAR) is associated with decreased perioperative morbidity and access site complications. We hypothesized that PEVAR for ruptured AAA (rPEVAR) may also improve perioperative morbidity compared to open femoral exposure (rEVAR). There are currently no reports that evaluate the utility and outcomes of rPEVAR.
From 2015 to 2021, all patients who underwent an endovascular repair of a ruptured AAA at a single institution were included in the study and grouped into rPEVAR and rEVAR. Demographics, procedural details (successful preclose technique, conversion to femoral cutdown), postoperative variables (blood transfusion, ICU and hospital length of stay) and short-term outcomes (30-day major adverse events (30-day MAE) and 30-day femoral access-site complications (30-day FAAC)) were collected and compared with 50 historical ePEVAR patients from the PEVAR Trial. Statistical significance was determined using or Fisher's exact test for categorical variables, and Mann-Whitney -test for continuous variables.
35 patients were identified (21 rPEVAR; 14 rEVAR), 86% were male with a mean age of 72 ± 9 years. All patients underwent emergent endovascular aortic repair with 100% technical success. Seventeen patients (49%) presented with evidence of hemorrhagic shock and 22 patients (63%) had blood transfusion. 30-day MAE occurred in 12 patients (34%) (7 rPEVAR; 5 rEVAR). There was no difference in demographic, perioperative outcomes and 30-day MAE rate between rPEVAR and rEVAR patients. Compared to ePEVAR patient (from PEVAR trial), rPEVAR patients had higher rate of 30-day MAE (34% vs. 6%; < 0.006) but no difference in 30-day FAAC (19% vs. 12%; = 0.54). The success rate of the preclose technique was higher in ePEVAR compared to rPEVAR (96% vs. 76%; = 0.02), but the rate of conversion to femoral cutdown was similar between the two groups (10% vs. 4%; = 0.57).
Emergent rPEVAR appears to have similar outcomes when compared to rEVAR. Although patients undergoing rPEVAR have higher 30-day major adverse events rate compared to ePEVAR, the method of percutaneous femoral cannulation does not appear to increase the overall procedural or 30-day femoral artery access-site complications.
PEVAR试验表明，与开放股动脉暴露相比，择期经皮血管腔内腹主动脉瘤修复术（ePEVAR）可降低围手术期发病率和穿刺部位并发症。我们推测，与开放股动脉暴露（rEVAR）相比，破裂腹主动脉瘤的血管腔内修复术（rPEVAR）也可能改善围手术期发病率。目前尚无评估rPEVAR的效用和结果的报告。
2015年至2021年，在单一机构接受破裂腹主动脉瘤血管腔内修复术的所有患者纳入本研究，并分为rPEVAR组和rEVAR组。收集人口统计学资料、手术细节（成功的预闭合技术、转为股动脉切开术）、术后变量（输血、重症监护病房和住院时间）和短期结果（30天主要不良事件（30天MAE）和30天股动脉穿刺部位并发症（30天FAAC）），并与PEVAR试验中的50例历史ePEVAR患者进行比较。分类变量采用卡方检验或Fisher精确检验确定统计学意义，连续变量采用Mann-Whitney U检验。
共纳入35例患者（21例rPEVAR；14例rEVAR），86%为男性，平均年龄72±9岁。所有患者均接受了急诊血管腔内主动脉修复术，技术成功率为100%。17例患者（49%）有失血性休克证据，22例患者（63%）接受了输血。12例患者（34%）发生30天MAE（7例rPEVAR；5例rEVAR）。rPEVAR组和rEVAR组患者在人口统计学、围手术期结果和30天MAE发生率方面无差异。与PEVAR试验中的ePEVAR患者相比，rPEVAR患者的30天MAE发生率更高（34%对6%；P<0.006），但30天FAAC无差异（19%对12%；P=0.54）。ePEVAR组的预闭合技术成功率高于rPEVAR组（96%对76%；P=0.02），但两组转为股动脉切开术的发生率相似（10%对4%；P=0.57）。
与rEVAR相比，急诊rPEVAR似乎有相似的结果。虽然与ePEVAR相比，接受rPEVAR的患者30天主要不良事件发生率更高，但经皮股动脉插管方法似乎不会增加总体手术或30天股动脉穿刺部位并发症。
