The impact of concomitant procedures during endovascular abdominal aortic aneurysm repair on perioperative outcomes.
The impact of concomitant procedures during endovascular abdominal aortic aneurysm repair on perioperative outcomes.
复制标题
腹主动脉瘤腔内修复期间伴随手术对围手术期结果的影响。
DOI：
10.1016/j.jvs.2015.12.039
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发表时间：
2016
影响因子：
4.3
通讯作者：
VascularStudyGroupofNewEngland
中科院分区：
文献类型：
--
作者：
Ultee,KlaasHJ;Zettervall,SaraL;Soden,PeterA;Darling,Jeremy;Siracuse,JeffreyJ;Alef,MatthewJ;Verhagen,HenceJM;Schermerhorn,MarcL;VascularStudyGroupofNewEngland
背景腹主动脉瘤腔内修复术（EVAR）期间的伴随手术是为了促进覆膜支架输送，同时治疗不相关的疾病，或解决术中陷阱。这些手术的频率和围手术期影响没有得到很好的描述。本研究的目的是评估的频率和围手术期的影响，在EVAR.MethodsWe的时间进行的各种伴随程序包括在血管研究组的新英格兰2003年1月至2014年11月之间的所有择期腹主动脉瘤腔内修复术，并确定那些与和那些没有伴随程序。多变量Logistic回归分析被用来建立独立的关联伴随程序和围手术期outcome.ResultsThe研究包括4033例患者，1168（29.0%）患者接受一个或多个额外的程序。30天死亡率的独立风险因素为合并股动脉内膜切除术（比值比[OR]，4.8; 95%置信区间[CI]，2.1-11.2）和肾血管成形术或支架植入术（OR，3.1; 95% CI，1.2-8.3）。术后肠缺血与下腹栓塞（OR，3.8; 95% CI，1.1-13.4）和髂动脉血管成形术或支架植入术（OR，3.5; 95% CI，1.3-9.6）相关。下肢缺血与计划外移植物延伸（OR，2.3; 95% CI，1.02-5.0）、其他动脉重建（OR，5.2; 95% CI，1.8-15.1）、血栓栓塞切除术（OR，5.2; 95% CI，1.3-20.8）和动脉损伤修复（OR，4.6; 95% CI，1.2-18.3）相关。肾功能恶化的风险因素为髂股动脉搭桥术（OR，3.9; 95% CI，1.3-12.2）、其他动脉重建术（OR，2.7; 95% CI，1.3-5.8）、肾血管成形术或支架植入术（OR，2.5; 95% CI，1.3-4.6）和动脉损伤修复术（OR，4.5; 95% CI，1.6-12.2）。心肌梗死与股动脉搭桥术（OR，3.9; 95% CI，1.7-8.7）、其他动脉重建术（OR，3.9; 95% CI，1.6-9.2）和动脉损伤修复术（OR，6.1; 95% CI，1.8-21.0）相关。伤口并发症通过股-股分流术预测（OR，13.4; 95%CI，5.8-31.1）。结论腹主动脉瘤腔内修复术期间的伴随手术与术后发病率和死亡率增加相关。应仔细考虑是否需要进行伴随手术。与术中并发症相关的发病率强调了尽可能避免动脉损伤和血栓栓塞事件的重要性。
BackgroundConcomitant procedures during endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm are performed to facilitate endograft delivery, to simultaneously treat unrelated conditions, or to resolve intraoperative pitfalls. The frequency and perioperative impact of these procedures are not well described. This study aimed to assess the frequency and perioperative impact of various concomitant procedures performed at the time of EVAR.MethodsWe included all elective EVARs in the Vascular Study Group of New England between January 2003 and November 2014 and identified those with and those without concomitant procedures. Multivariable logistic regression analysis was used to establish the independent association between concomitant procedures and perioperative outcomes.ResultsThe study included 4033 patients, with 1168 (29.0%) patients undergoing one or more additional procedures. Independent risk factors for 30-day mortality were concomitant femoral endarterectomy (odds ratio [OR], 4.8; 95% confidence interval [CI], 2.1-11.2) and renal angioplasty or stenting (OR, 3.1; 95% CI, 1.2-8.3). Postoperative bowel ischemia was associated with hypogastric embolization (OR, 3.8; 95% CI, 1.1-13.4) and iliac angioplasty or stenting (OR, 3.5; 95% CI, 1.3-9.6). Leg ischemia was associated with unplanned graft extension (OR, 2.3; 95% CI, 1.02-5.0), other artery reconstruction (OR, 5.2; 95% CI, 1.8-15.1), thromboembolectomy (OR, 5.2; 95% CI, 1.3-20.8), and repair of arterial injury (OR, 4.6; 95% CI, 1.2-18.3). Risk factors for deterioration of renal function were iliofemoral bypass (OR, 3.9; 95% CI, 1.3-12.2), other artery reconstruction (OR, 2.7; 95% CI, 1.3-5.8), renal angioplasty or stenting (OR, 2.5; 95% CI, 1.3-4.6), and repair of arterial injury (OR, 4.5; 95% CI, 1.6-12.2). Myocardial infarction was associated with femorofemoral bypass (OR, 3.9; 95% CI, 1.7-8.7), other artery reconstruction (OR, 3.9; 95% CI, 1.6-9.2), and repair of arterial injury (OR, 6.1; 95% CI, 1.8-21.0). Wound complications were predicted by femorofemoral bypass (OR, 13.4; 95% CI, 5.8-31.1).ConclusionsConcomitant procedures during EVAR are associated with increased postoperative morbidity and mortality. The need for performing concomitant procedures should be carefully considered. The morbidity associated with intraoperative complications highlights the importance of avoidance of arterial injury and thromboembolic events where possible.
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