Fenestrated endovascular repair of abdominal aortic aneurysms is associated with increased morbidity but comparable mortality with infrarenal endovascular aneurysm repair
Fenestrated endovascular repair of abdominal aortic aneurysms is associated with increased morbidity but comparable mortality with infrarenal endovascular aneurysm repair
复制标题
DOI：
10.1016/j.jvs.2014.10.025
复制
发表时间：
2015-03-01
影响因子：
4.3
通讯作者：
Abularrage, Christopher J.
中科院分区：
文献类型：
--
作者：
Glebova, Natalia O.;Selvarajah, Shalini;Abularrage, Christopher J.
目的：最近的一项前瞻性研究发现，在经验丰富的临床试验机构，开孔型腹主动脉瘤（AAA）腔内修复术（FEVAR）在适当选择的患者中安全有效。随着这项新技术向社区传播，了解这项技术与标准腹主动脉瘤腔内修复术（EVAR）的比较情况将非常重要。本研究的目的是比较腹主动脉瘤腔内修复术与腹主动脉瘤腔内修复术治疗AAA的结局。方法：对2005年至2012年美国外科医师学会-国家外科质量改进计划数据库中的AAA（国际疾病分类，第九次修订代码441. 4）进行查询。根据手术（FEVAR vs EVAR）对患者进行分层。进行了双变量分析，以评估术前和术中术后结局的风险因素。描述了每种手术类型的术后30天死亡率和并发症发生率。进行多变量logistic回归以评估手术类型与术后并发症风险之间的相关性。结果：共有458例患者接受了FEVAR，19，060例患者接受了腹主动脉瘤腹主动脉瘤腔内修复术。接受FEVAR的患者年龄较大（P =.02），出血性疾病的可能性较小（P =.046）。除此之外，两组的合并症发生率相似。FEVAR与中位手术时间（156 vs 137分钟; P <0.001）和平均术后住院时间（3.3 vs 2.8天; P = 0.03）增加相关。总体并发症有统计学显著增加（23.6% vs 14.3%; P <.001）和术后输血（15.3% vs 6.1%，P <.001）和心脏并发症增加的趋势（2.2% vs 1.3%; P = 0.09）和需要透析（1.5% vs 0.8%; P = 0.08）。死亡率（2.4% vs 1.5%; P = 0.12）无统计学差异。在多变量分析中，当手术时间为相应手术的第75百分位数时，FEVAR仍然与术后输血需求独立相关（校正比值比，5.33; 95%可信区间，3.55 - 8.00; P <0.001）。接受FEVAR的患者比接受EVAR的患者更有可能在术后接受输血，术后并发症虽然死亡率相似，但心脏和肾脏并发症增加的趋势可能表明需要明智地传播这项新技术。未来有必要对更多FEVAR病例进行研究，以确定这些相关性是否仍然存在。
Objective: A recent prospective study found that fenestrated endovascular abdominal aortic aneurysm (AAA) repair (FEVAR) was safe and effective in appropriately selected patients at experienced centers. As this new technology is disseminated to the community, it will be important to understand how this technology compares with standard endovascular AAA repair (EVAR). The goal of this study was to compare the outcomes of FEVAR vs EVAR of AAAs.Methods: The American College of Surgeons-National Surgical Quality Improvement Program database from 2005 to 2012 was queried for AAAs (International Classification of Diseases, Ninth Revision code 441.4). Patients were stratified according to procedure (FEVAR vs EVAR). A bivariate analysis was done to assess preoperative and intraoperative risk factors for postoperative outcomes. Thirty-day postoperative mortality and complication rates were described for each procedure type. Multivariable logistic regression was performed to assess the association between the type of procedure and the risk of postoperative complications.Results: A total of 458 patients underwent FEVAR and 19,060 patients underwent EVAR for AAA. Patients undergoing FEVAR were older (P = .02) and less likely to have a bleeding disorder (P = .046). Otherwise, the incidence of comorbidities in both groups was similar. FEVAR was associated with increased median operative time (156 vs 137 minutes; P < .001), and average postoperative length of stay (3.3 vs 2.8 days; P = .03). There was a statistically significant increase in overall complications (23.6% vs 14.3%; P < .001) and postoperative transfusions (15.3% vs 6.1%, P < .001) and trends toward increased cardiac complications (2.2% vs 1.3%; P = .09) and the need for dialysis (1.5% vs 0.8%; P = .08) in the FEVAR group. Mortality (2.4% vs 1.5%; P = .12) was not statistically different. On multivariable analysis, FEVAR remained independently associated with the need for postoperative transfusions when operative time was 75th percentile for respective procedures (adjusted odds ratio, 5.33; 95% confidence interval, 3.55-8.00; P < .001).Conclusions: Patients undergoing FEVAR are more likely than patients undergoing EVAR to receive blood transfusions postoperatively and are more likely to sustain postoperative complications. Although mortality was similar, trends toward increased cardiac and renal complications may suggest the need for judicious dissemination of this new technology. Future research with larger number of FEVAR cases will be necessary to determine if these associations remain.