Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
Vascular Centre, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden.
Br J Surg. 2024 Oct 30;111(11). doi: 10.1093/bjs/znae279.
A juxtarenal abdominal aortic aneurysm is defined as a short (less than 4 mm) or no-neck aneurysm, which is often treated with open or complex endovascular repair. The evidence to support the best treatment strategy is scarce. The aim of this study was to assess the short- and mid-term outcomes of elective open surgical repair or fenestrated endovascular aneurysm repair for juxtarenal abdominal aortic aneurysms in Sweden.
Patients who underwent elective open surgical repair or fenestrated endovascular aneurysm repair for juxtarenal abdominal aortic aneurysms between 2018 and 2021 were identified in the Swedish Vascular Registry. Demographics, practice patterns, and operative details were assessed. The primary outcome was 30-day mortality. Secondary outcomes included perioperative complications and mid-term survival.
Among 3777 aortic aneurysm repairs performed, 418 involved juxtarenal abdominal aortic aneurysms (open surgical repair 228 (54.5%), fenestrated endovascular aneurysm repair 176 (42.1%), chimney endovascular aneurysm repair 6 (1.4%), and branched endovascular aneurysm repair 8 (1.9%)). Some 25 centres performed juxtarenal abdominal aortic aneurysm repairs with open surgical repair and fenestrated endovascular aneurysm repair. The caseload varied from 2 to 54 repairs per centre. The mean aneurysm diameter was 61 mm. Endovascularly treated patients were older and had more pulmonary co-morbidities. The 30-day mortality rate was 2.2% (open surgical repair 2.6% and fenestrated endovascular aneurysm repair 1.7%; P = 0.397). Perioperative major complications occurred in 14.1% of patients (open surgical repair 19.3% and fenestrated endovascular aneurysm repair 7.4%; P < 0.001) and perioperative vascular complications occurred in 12.1% of patients (open surgical repair 8.8% and fenestrated endovascular aneurysm repair 11.9%; P = 0.190). The survival rate (estimated using Kaplan-Meier analysis) at 1 year and 3 years was 93.1% and 85.9% respectively for open surgical repair and 95.2% and 80.9% respectively for fenestrated endovascular aneurysm repair (P = 0.477).
This nationwide study reveals considerable variations in volume and treatment strategy between Swedish centres performing juxtarenal abdominal aortic aneurysm repairs. Survival is comparable for open surgical repair and fenestrated endovascular aneurysm repair, although there are significant baseline demographic differences between patients selected for the two treatment modalities.
肾周腹主动脉瘤被定义为短（小于 4 毫米）或无瘤颈的动脉瘤，通常采用开放或复杂的血管内修复治疗。支持最佳治疗策略的证据很少。本研究旨在评估瑞典肾周腹主动脉瘤选择性开放手术修复或开窗血管内修复的短期和中期结果。
在瑞典血管登记处确定了 2018 年至 2021 年间接受选择性开放手术修复或开窗血管内修复治疗的肾周腹主动脉瘤患者。评估了人口统计学、实践模式和手术细节。主要结果是 30 天死亡率。次要结果包括围手术期并发症和中期生存率。
在 3777 例主动脉瘤修复中，418 例涉及肾周腹主动脉瘤（开放手术修复 228 例[54.5%]，开窗血管内修复 176 例[42.1%]，烟囱血管内修复 6 例[1.4%]，和分支血管内修复 8 例[1.9%]）。25 个中心进行了肾周腹主动脉瘤修复术，其中开放手术修复和开窗血管内修复各有 25 个中心。每个中心的病例数从 2 例到 54 例不等。平均动脉瘤直径为 61 毫米。血管内治疗的患者年龄较大，且有更多的肺部合并症。30 天死亡率为 2.2%（开放手术修复为 2.6%，开窗血管内修复为 1.7%；P=0.397）。围手术期主要并发症发生率为 14.1%（开放手术修复为 19.3%，开窗血管内修复为 7.4%；P<0.001），围手术期血管并发症发生率为 12.1%（开放手术修复为 8.8%，开窗血管内修复为 11.9%；P=0.190）。Kaplan-Meier 分析估计的 1 年和 3 年生存率分别为开放手术修复 93.1%和 85.9%，开窗血管内修复 95.2%和 80.9%（P=0.477）。
这项全国性研究揭示了瑞典进行肾周腹主动脉瘤修复的中心之间在数量和治疗策略上存在相当大的差异。开放手术修复和开窗血管内修复的生存率相当，尽管两种治疗方式选择的患者之间存在显著的基线人口统计学差异。
