Ma Huibo, Wang Xueyi, Liu Yangshuo, Li Yongxin, Guo Mingjin
Department of Vascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Department of Vascular Surgery, Rongcheng People's Hospital, Weihai, China.
Front Cardiovasc Med. 2024 Mar 13;11:1272389. doi: 10.3389/fcvm.2024.1272389. eCollection 2024.
Ruptured abdominal aortic aneurysm (rAAA) represents a critically urgent vascular surgical condition, and endovascular aneurysm repair (EVAR) is a clinically effective treatment option. This study aims to investigate whether the type of intravascular graft used for ruptured abdominal aortic aneurysms has an impact on perioperative outcomes of EVAR.
A retrospective analysis was conducted on patients who underwent EVAR for ruptured abdominal aortic aneurysm at a single medical center from 2019 to 2022. Patients who required simultaneous stent implantation in the renal arteries or visceral arteries, as well as those with ruptured aneurysms located in the para-renal, supra-renal, or thoracoabdominal regions, were excluded from the analysis. Additionally, patients who underwent open surgery during the initial procedure or converted to open repair were excluded. The primary endpoint was perioperative mortality rate. Other study outcomes included perioperative complications, reoperation rates, and length of hospital stay. Characteristics and corresponding outcomes of patients receiving different endovascular stent treatments were compared using SPSS software.
A total of 58 patients received treatment with two types of endovascular stents: Gore Excluder ( = 29) and Microport Hercules ( = 29). The number of other endografts was too small for statistical analysis. Compared to patients treated with Hercules, those treated with Excluder had a significantly increased likelihood of concomitant coronary atherosclerosis ( = 0.009) and potentially higher creatinine levels ( = 0.014). Additionally, Excluder was more commonly used in patients with shorter aneurysm necks ( < 0.001). There was a statistically significant difference in overall mortality between the two groups (Hercules 27.6%, Excluder 6.9%, = 0.037). Furthermore, patients who received Excluder treatment had lower mortality rates in subgroups of non-alcohol users ( = 0.028), non-diabetic patients ( = 0.027), and patients with dispersed thrombosis at the proximal neck ( = 0.046). In the multivariate analysis, the type of stent used (OR 0.06, 95% CI 0.00-1.31) and the occurrence of intraoperative complications (OR 20.70, 95% CI 1.14-76.70) in patients with rAAA was identified as an independent risk factor for perioperative mortality.
Our study suggests that the management of intraoperative complications may be a modifiable factor that can improve outcomes. Patients receiving Excluder treatment demonstrated better performance in EVAR for single-center rAAA patients compared to other endovascular stents, and this difference warrants further investigation.
腹主动脉瘤破裂（rAAA）是一种极其危急的血管外科疾病，而血管腔内动脉瘤修复术（EVAR）是一种临床有效的治疗选择。本研究旨在探讨用于破裂腹主动脉瘤的血管内移植物类型是否会对EVAR的围手术期结局产生影响。
对2019年至2022年在单一医疗中心接受EVAR治疗破裂腹主动脉瘤的患者进行回顾性分析。需要同时在肾动脉或内脏动脉植入支架的患者，以及动脉瘤位于肾旁、肾上或胸腹段的破裂患者被排除在分析之外。此外，在初次手术期间接受开放手术或转为开放修复的患者也被排除。主要终点是围手术期死亡率。其他研究结局包括围手术期并发症、再次手术率和住院时间。使用SPSS软件比较接受不同血管内支架治疗的患者的特征及相应结局。
共有58例患者接受了两种血管内支架治疗：戈尔覆膜支架（n = 29）和微创 Hercules支架（n = 29）。其他血管内移植物的数量太少，无法进行统计分析。与接受Hercules支架治疗的患者相比，接受Excluder支架治疗的患者合并冠状动脉粥样硬化的可能性显著增加（P = 0.009），肌酐水平可能更高（P = 0.014）。此外，Excluder支架更常用于瘤颈较短的患者（P < 0.001）。两组的总死亡率存在统计学差异（Hercules支架组为27.6%，Excluder支架组为6.9%，P = 0.037）。此外，接受Excluder支架治疗的患者在非饮酒者亚组（P = 0.028）、非糖尿病患者亚组（P = 0.027）以及近端瘤颈处有散在血栓形成的患者亚组（P = 0.046）中的死亡率较低。在多变量分析中，rAAA患者使用的支架类型（OR 0.06，95%CI 0.00 - 1.31）和术中并发症的发生（OR 20.70，95%CI 1.14 - 76.70）被确定为围手术期死亡的独立危险因素。
我们的研究表明，术中并发症的处理可能是一个可改变的因素，可以改善结局。与其他血管内支架相比，接受Excluder支架治疗的患者在单中心rAAA患者的EVAR中表现更好，这种差异值得进一步研究。
