Endovascular suture versus cutdown for endovascular aneurysm repair: A prospective randomized pilot study
Endovascular suture versus cutdown for endovascular aneurysm repair: A prospective randomized pilot study
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DOI：
10.1016/s0741-5214(02)75454-2
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发表时间：
2003-07-01
影响因子：
4.3
通讯作者：
Torsello, GF
中科院分区：
文献类型：
--
作者：
Torsello, GB;Kasprzak, B;Torsello, GF
目的：为了评估经皮技术治疗主动脉瘤的安全性和成本效益，进行了一项前瞻性随机研究，比较了血管内缝合技术与传统的切开进入和修复技术。材料与方法。从2002年1月到2002年7月，30例血管内动脉瘤患者接受了30例血管内动脉瘤治疗，其中包括14例Talent支架移植（美敦力，Sunrise, Fla）和16例Zenith支架移植（Cook, Bloomington, Ind）。患者随机分为经皮穿刺组（A组）和常规切口组（B组）。用大口径（14F-25F）导管插管55条股动脉纳入研究。通过记录并发症发生率、手术时间、出院时间和下床时间来评估两种技术的安全性和有效性。所选估计费用的比较包括股骨通路的可变费用和固定费用以及治疗并发症的费用。无手术死亡发生。两组的并发症发生率相似，分别为1例动脉血栓形成，B组3例淋巴细胞瘤，a组1例因出血转术，平均手术时间（86.7 +/- 27分钟vs 107.8 +/- 38.5分钟，P < 0.05）和下床时间（20.1 +/- 4.3小时vs 33.1 +/- 18.4小时，P < 0.001）明显缩短。由于关闭装置的成本，经皮穿刺技术的总成本比切口平均高出99.2欧元。经皮技术减少了动脉瘤腔内治疗的侵入性，减少了手术时间和走动时间。并发症的严重程度大致相同。该设备的额外费用似乎证明了它用于这种形式的动脉瘤治疗是合理的。
Purpose: To evaluate safety and cost benefits of the percutaneous technique for treatment of aortic aneurysm, a prospective randomized study was performed that compared the endovascular suture technique with conventional cutdown access and repair.Materials and Methods. From January 2002 through July 2002, 30 endografts, including 14 Talent stent-grafts (Medtronic, Sunrise, Fla) and 16 Zenith endografts (Cook, Bloomington, Ind) were implanted in 30 patients for endovascular aneurysm treatment. The patients were randomized to either percutaneous technique (group A) or conventional cutdown (group B). Fifty-five femoral arteries were cannulated with large-bore (14F-25F) introducers and were included in the study. Safety and efficiency of both techniques were assessed by recording the complication rates, operation time, discharge, and time to ambulation. Comparison of selected estimated costs included both variable and fixed costs for femoral access and expenses for treatment of complications.Results. No operative deaths occurred. The complication rates were similar and included I arterial thrombosis in each group, 3 lymphoceles in group B, and 1 conversion to cutdown because of bleeding in group A. Mean surgery time (86.7 +/- 27 minutes vs 107.8 +/- 38.5 minutes; P < .05) and time to ambulation (20.1 +/- 4.3 hours vs 33.1 +/- 18.4 hours; P < .001) were significantly shorter in the group treated percutaneously. Because of the cost of the closure device, total cost of the percutaneous technique averaged 99.2 EURO more than cutdown.Conclusions. The percutaneous technique decreases the invasiveness of endovascular therapy of aortic aneurysm and reduces operative time and time to ambulation. Complications were roughly equivalent in severity. The additional cost for the device appears to justify its use for this form of aneurysm treatment.