编辑推荐——各国完整和破裂动脉瘤修复后的结果：对2014 - 2019年VASCUNET合作组织国际注册数据的分析
Editor's Choice - Outcomes Following Intact and Ruptured Aneurysm Repair across Nations: Analysis of International Registry Data from the VASCUNET Collaboration 2014 - 2019.
作者信息
Pherwani Arun D, Johal Amundeep S, Cromwell David A, Boyle Jonathan R, Szeberin Zoltan, Venermo Maarit, Beiles Barry, Khashram Manar, Lattmann Thomas, Altreuther Martin E, Laxdal Elin, Behrendt Christian-Alexander, Mani Kevin, Budtz-Lilly Jacob
机构信息
Keele University School of Medicine, Department of Vascular Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK.
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK. Electronic address: http://www.twitter.com/vsqip.
出版信息
Eur J Vasc Endovasc Surg. 2024 Aug;68(2):162-170. doi: 10.1016/j.ejvs.2024.02.019. Epub 2024 Feb 19.
OBJECTIVE
To determine the peri-operative mortality rate for intact and ruptured abdominal aortic aneurysm (AAA) repair in 10 countries and to compare practice and outcomes over a six year period by age, sex, and geographic location.
METHODS
This VASCUNET study used prospectively collected data from vascular registries in 10 countries on primary repair of intact and ruptured AAAs undertaken between January 2014 and December 2019. The primary outcome was peri-operative death (30 day or in hospital). Logistic regression models were used to estimate the association between peri-operative death, patient characteristics, and type of procedure. Factors associated with the use of endovascular aortic aneurysm repair (EVAR) were also evaluated.
RESULTS
The analysis included 50 642 intact and 9 453 ruptured AAA repairs. The proportion of EVARs for intact repairs increased from 63.4% in 2014 to 67.3% in 2016 before falling to 62.3% in 2019 (p < .001), but practice varied between countries. EVAR procedures were more common among older patients (p < .001) and men (p < .001). Overall peri-operative mortality after intact AAA repair was 1.4% (95% confidence interval [CI] 1.3 - 1.5%) and did not change over time. Mortality rates were stable within countries. Among ruptured AAA repairs, the proportion of EVARs increased from 23.7% in 2014 to 35.2% in 2019 (p < .001). The average aortic diameter was 7.8 cm for men and 7.0 cm for women (p < .001). The overall peri-operative mortality rate was 31.3% (95% CI 30.4 - 32.2%); the rates were 36.0% (95% CI 34.9 - 37.2%) for open repair and 19.7% (95% CI 18.2 - 21.3%) for EVAR. This difference and shift to EVAR reduced peri-operative mortality from 32.6% (in 2014) to 28.7% (in 2019).
CONCLUSION
The international practice of intact AAA repair was associated with low mortality rates in registry reported data. There remains variation in the use of EVAR for intact AAAs across countries. Overall peri-operative mortality remains high after ruptured AAA, but an increased use of EVAR has reduced rates over time.
目的
确定10个国家腹主动脉瘤（AAA）完整修复和破裂修复的围手术期死亡率，并按年龄、性别和地理位置比较6年期间的手术操作和结果。
方法
这项VASCUNET研究前瞻性收集了10个国家血管登记处2014年1月至2019年12月期间对完整和破裂AAA进行初次修复的数据。主要结局是围手术期死亡（30天内或住院期间）。使用逻辑回归模型估计围手术期死亡、患者特征和手术类型之间的关联。还评估了与血管内腹主动脉瘤修复（EVAR）使用相关的因素。
结果
分析包括50642例完整AAA修复和9453例破裂AAA修复。完整修复中EVAR的比例从2014年的63.4%增加到2016年的67.3%，然后在2019年降至62.3%（p<0.001），但各国的手术操作存在差异。EVAR手术在老年患者（p<0.001）和男性（p<0.001）中更常见。完整AAA修复后的总体围手术期死亡率为1.4%（95%置信区间[CI]1.3-1.5%），且随时间未发生变化。各国的死亡率保持稳定。在破裂AAA修复中，EVAR的比例从2014年的23.7%增加到2019年的35.2%（p<0.001）。男性的平均主动脉直径为7.8cm，女性为7.0cm（p<0.001）。总体围手术期死亡率为31.3%（95%CI 30.4-32.2%）；开放修复的死亡率为36.0%（95%CI 34.9-37.2%），EVAR为19.7%（95%CI 18.2-21.3%）。这种差异以及向EVAR的转变使围手术期死亡率从2014年的32.6%降至2019年的28.7%。
结论
在登记报告的数据中，国际上对完整AAA修复的操作与低死亡率相关。各国在完整AAA中使用EVAR的情况仍存在差异。破裂AAA后的总体围手术期死亡率仍然很高，但随着时间的推移，EVAR使用的增加降低了死亡率。
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