Mirabella Domenico, Bruno Salvatore, La Marca Manfredi Agostino, Dinoto Ettore, Rodriquenz Edoardo, Miccichè Andrea, Pecoraro Felice
Vascular Surgery Unit, AOUP Policlinico "P. Giaccone", 90127 Palermo, Italy.
Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90133 Palermo, Italy.
Life (Basel). 2024 Sep 4;14(9):1113. doi: 10.3390/life14091113.
Endovascular aneurysm repair (EVAR) has become the preferred approach over open repair for abdominal aortic aneurysms (AAAs) due to its minimally invasive nature. The common femoral artery (CFA) is the main access vessel for EVAR, with both surgical exposure and percutaneous access being utilized. However, in emergent cases, percutaneous access can be challenging and may result in complications such as bleeding or dissection thrombosis, leading to the need for surgical conversion. This study aimed to share experiences in implementing a decision-making algorithm to reduce surgical conversions due to percutaneous access failures. A total of 74 aortic patients treated with EVAR in emergency settings were included in this retrospective study. This study focused on various outcomes such as perioperative mortality, morbidity, procedure time, surgical exposure time, and surgical conversion rate. After the implementation of the decision-making algorithm, decreases in surgical conversions and operating time were observed. Percutaneous access was found to be more challenging in cases with specific anatomical characteristics of the CFA, such as severe atherosclerosis or smaller vessel diameter. This study highlighted the importance of carefully assessing patient anatomical features and utilizing a decision-making algorithm to optimize outcomes in EVAR procedures. Further research is needed to continue improving practices for managing aortic aneurysms and reducing complications in femoral artery access approaches.
由于血管内动脉瘤修复术（EVAR）具有微创性，它已成为腹主动脉瘤（AAA）开放修复术的首选方法。股总动脉（CFA）是EVAR的主要入路血管，手术暴露和经皮穿刺入路均可采用。然而，在紧急情况下，经皮穿刺入路可能具有挑战性，可能导致出血或夹层血栓形成等并发症，从而需要转为手术治疗。本研究旨在分享实施决策算法以减少因经皮穿刺失败导致手术转为开放手术的经验。本回顾性研究纳入了74例在急诊情况下接受EVAR治疗的主动脉疾病患者。本研究关注围手术期死亡率、发病率、手术时间、手术暴露时间和手术转化率等各种结果。实施决策算法后，手术转化率和手术时间均有所下降。发现CFA具有特定解剖特征的病例，如严重动脉粥样硬化或血管直径较小，经皮穿刺入路更具挑战性。本研究强调了仔细评估患者解剖特征并利用决策算法优化EVAR手术结果的重要性。需要进一步研究以继续改进主动脉瘤管理实践并减少股动脉入路方法中的并发症。
