Department of Surgery, University of Auckland, Auckland, NZ; Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, NZ.
Department of Population Health Sciences, Weill Cornell Medical College, New York, NY.
J Vasc Surg. 2024 Apr;79(4):748-754.e2. doi: 10.1016/j.jvs.2023.11.033. Epub 2023 Nov 25.
The mortality after ruptured abdominal aortic aneurysm (rAAA) repair is high, despite improvements in perioperative care, centralization of emergency vascular surgical services, and the introduction of endovascular aneurysm repair (EVAR). The diameter of intact AAA has been shown to be a predictor of short- and long-term survival. The aim of this study was to analyze the impact of AAA diameter on mortality for rAAA repair using contemporary data collected from the International Consortium of Vascular Registries and compare outcomes by sex and the type of repair patients received.
Prospective registry data on repair of rAAA from seven countries were collected from 2010 to 2016. The primary outcome was perioperative mortality after EVAR and open surgical repair (OSR). Data were stratified by type of repair and sex. Logistic regression models were used to estimate odds ratio (OR) for the association between AAA diameter and perioperative mortality and the association between type of repair and mortality. Multivariable logistic regression models were used to adjust for differences in patient characteristics.
The study population consisted of 6428 patients with a mean age ranging from 70.2 to 75.4 years; the mean AAA diameter was 7.7 ± 1.8 cm. Females had a significantly smaller AAA diameter at presentation compared with males (6.9 ± 1.6 cm vs 7.9 ± 1.8 cm; P < .001). who underwent OSR had larger AAA diameters compared with those who underwent EVAR (P < .001). Females who underwent repair were significantly older (P < .001). Males were more likely to have cardiac disease, diabetes mellitus, and renal impairment. Overall, AAA diameter was a predictor of mortality in univariate and multivariate analysis. When analyzing EVAR and OSR separately, the impact of AAA diameter per cm increase on mortality was apparent in both males and females undergoing EVAR, but not OSR (EVAR: male OR, 1.09 [95% confidence interval, 1.03-1.16] and EVAR: female OR, 1.17 [95% confidence interval, 1.02-1.35]). The early mortality rate for males and females who underwent EVAR was 18.9% and 25.9% (P < .001), respectively. The corresponding mortality for males and females who underwent OSR was 30.2% and 38.6% (P < .001), respectively.
In these real-world international data, there is a significant association between rAAA diameters and early mortality in males and females. This association was more evident in patients undergoing EVAR, but not shown in OSR. Despite improvements in overall AAA repair outcomes, the risk of mortality after rAAA repair is consistently higher for females.
尽管围手术期护理、紧急血管外科学服务的集中化以及血管内动脉瘤修复术（EVAR）的引入均改善了腹主动脉瘤破裂（rAAA）修复术后的死亡率，但仍居高不下。AAA 完整直径已被证明是短期和长期生存的预测指标。本研究旨在使用来自国际血管登记处联合会的当代数据来分析 rAAA 修复术后 AAA 直径对死亡率的影响，并比较男女之间和患者接受的修复类型的结果。
2010 年至 2016 年，从七个国家收集了关于 rAAA 修复的前瞻性登记数据。主要结局是 EVAR 和开放式外科修复（OSR）后的围手术期死亡率。数据按修复类型和性别分层。使用逻辑回归模型来估计 AAA 直径与围手术期死亡率之间的比值比（OR）以及修复类型与死亡率之间的关联。使用多变量逻辑回归模型来调整患者特征的差异。
该研究人群由 6428 例平均年龄在 70.2 至 75.4 岁之间的患者组成；AAA 平均直径为 7.7±1.8cm。与男性相比，女性的 AAA 直径明显较小（6.9±1.6cm 比 7.9±1.8cm；P<0.001）。接受 OSR 的患者的 AAA 直径大于接受 EVAR 的患者（P<0.001）。接受修复的女性明显更年长（P<0.001）。男性更可能患有心脏病、糖尿病和肾功能不全。总体而言，AAA 直径是单变量和多变量分析中死亡率的预测指标。当分别分析 EVAR 和 OSR 时，AAA 直径每增加 1cm，男性和女性接受 EVAR 治疗的死亡率均明显升高，但接受 OSR 治疗的患者则不然（EVAR：男性 OR，1.09[95%置信区间，1.03-1.16]和 EVAR：女性 OR，1.17[95%置信区间，1.02-1.35]）。接受 EVAR 的男性和女性的早期死亡率分别为 18.9%和 25.9%（P<0.001）。接受 OSR 的男性和女性的相应死亡率分别为 30.2%和 38.6%（P<0.001）。
在这些真实世界的国际数据中，rAAA 直径与男性和女性的早期死亡率之间存在显著关联。这种关联在接受 EVAR 的患者中更为明显，但在 OSR 中并未显示。尽管 AAA 修复的总体结果有所改善，但 rAAA 修复后的死亡率仍然持续高于女性。
