Kim Sang Yoon, Yoon Dong Kyu, Lee Jae Hang, Chang Hyoung Woo, Park Kay-Hyun
Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital, Daejeon, Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
J Chest Surg. 2025 Sep 5;58(5):185-192. doi: 10.5090/jcs.24.116. Epub 2025 Jun 4.
Several studies have demonstrated that emergency endovascular aneurysm repair (eEVAR) has become the standard treatment for ruptured abdominal aortic aneurysm (rAAA) compared to open surgical repair (OSR). This study investigated the feasibility of eEVAR in rAAA patients and analyzed the outcomes of OSR.
At our institution, all patients (n=58) presenting with rAAA underwent OSR. We conducted a retrospective review of surgically treated rAAA patients between February 2006 and March 2021. Patients with impending rupture or isolated iliac aneurysm rupture were excluded.
Anatomic measurements based on preoperative computed tomography indicated that 28 patients (48.3%) could have been candidates for eEVAR. Reasons for unsuitability included: (1) proximal neck length <10 mm (n=21, 51.7%); (2) proximal neck angulation >60° (n=11, 19.0%); (3) iliac artery diameter <5 mm (n=6, 10.3%); and (4) proximal neck diameter >32 mm (n=3, 5.2%). The 30-day mortality rate for OSR was 17.2% (n=10). The 1-year and 5-year survival rates were 53.4%±6.5% and 33.4%±6.3%, respectively. Multivariable logistic regression analysis revealed that a high preoperative serum lactate level (>5 mmol/L) and the presence of bowel ischemia were significant risk factors for 30-day mortality (odds ratio [OR], 11.95; 95% confidence interval [CI], 1.53-93.08; p<0.018; and OR, 15.28; 95% CI, 1.60-146.18; p<0.018, respectively).
More than half of rAAA patients were not candidates for eEVAR due to various anatomical reasons. OSR demonstrated favorable short- and long-term outcomes and remains a viable standard treatment for rAAA.
多项研究表明，与开放手术修复（OSR）相比，急诊血管内动脉瘤修复术（eEVAR）已成为破裂腹主动脉瘤（rAAA）的标准治疗方法。本研究调查了eEVAR在rAAA患者中的可行性，并分析了OSR的治疗结果。
在我们机构，所有表现为rAAA的患者（n = 58）均接受了OSR。我们对2006年2月至2021年3月期间接受手术治疗的rAAA患者进行了回顾性研究。即将破裂或孤立性髂动脉瘤破裂的患者被排除。
基于术前计算机断层扫描的解剖学测量表明，28例患者（48.3%）可能适合eEVAR。不适合的原因包括：（1）近端颈部长度<10 mm（n = 21，51.7%）；（2）近端颈部角度>60°（n = 11，19.0%）；（3）髂动脉直径<5 mm（n = 6，10.3%）；以及（4）近端颈部直径>32 mm（n = 3，5.2%）。OSR的30天死亡率为17.2%（n = 10）。1年和5年生存率分别为53.4%±6.5%和33.4%±6.3%。多变量逻辑回归分析显示，术前血清乳酸水平高（>5 mmol/L）和存在肠缺血是30天死亡率的显著危险因素（比值比[OR]，11.95；95%置信区间[CI]，1.53 - 93.08；p<0.018；以及OR，15.28；95% CI，1.60 - 146.18；p<0.0
