Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan.
Mathematics and Statistics Section, Department of Fundamental Education, Dokkyo Medical University, 880 Kitakobayashi, Mibu-Machi, Simotuga-gun, Tochigi, 321-0293, Japan.
BMC Cardiovasc Disord. 2023 Sep 1;23(1):436. doi: 10.1186/s12872-023-03473-8.
Recent guidelines state that improving the survival rate of patients with ruptured abdominal aortic aneurysm (rAAA) requires a protocol or algorithm for the emergency management of these patients. We aimed to investigate whether introducing a protocol treatment for rAAA improves clinical outcomes compared with the pre-protocol strategy.
At our institution, 92 patients treated for rAAA between June 2008 and August 2022 were retrospectively analyzed. In 2014, the protocol-based treatment was introduced comprising a transfer algorithm to shorten the time to proximal control, use of an endovascular occlusion balloon, strict indications for endovascular aortic aneurysm repair (EVAR) or open surgical repair, and perioperative care, including for abdominal compartment syndrome (ACS). Clinical outcomes were compared between the protocol and pre-protocol group, including operative status, all-cause mortality, and rAAA-related death at 30-day, in-hospital, and 1-year postoperative follow-ups.
Overall, 52 and 40 patients received the protocol-based and pre-protocol treatments, respectively. EVAR was more frequently performed in the protocol group. The rate of achieving time to proximal control was significantly faster, and the transfusion volume was lower in the protocol group. ACS occurred more frequently in the protocol group with a higher EVAR. No difference was found in all-cause mortality between the two groups. The protocol group exhibited fewer rAAA-related deaths than the pre-protocol group during the following time points: 30 days (9.6% vs. 22.5%), during the hospital stay (11.5% vs. 30.0%), and 1 year (14.5% vs. 31.5%).
The protocol-based treatment improved the survival rate of patients with rAAA.
最近的指南指出，提高破裂性腹主动脉瘤（rAAA）患者的生存率需要针对这些患者制定紧急管理方案或算法。我们旨在研究引入 rAAA 协议治疗是否比预协议策略能改善临床结局。
我们回顾性分析了 2008 年 6 月至 2022 年 8 月期间在我院接受 rAAA 治疗的 92 例患者。2014 年，引入了基于方案的治疗方法，包括将近端控制时间缩短的转移算法、使用血管内闭塞球囊、严格的血管内主动脉瘤修复（EVAR）或开放手术修复适应证，以及围手术期护理，包括腹腔间隔室综合征（ACS）。比较了方案组和预方案组之间的临床结局，包括手术状态、全因死亡率以及术后 30 天、住院期间和 1 年的 rAAA 相关死亡率。
总体而言，52 例患者接受了基于方案的治疗，40 例患者接受了预方案治疗。方案组更常进行 EVAR。方案组达到近端控制时间的速度明显更快，输血量更低。方案组 ACS 发生率更高，EVAR 率也更高。两组间全因死亡率无差异。方案组在以下时间点的 rAAA 相关死亡率低于预方案组：30 天（9.6%比 22.5%）、住院期间（11.5%比 30.0%）和 1 年（14.5%比 31.5%）。
基于方案的治疗改善了 rAAA 患者的生存率。
