Comparison between Open and Endovascular Repair for the Treatment of Juxtarenal Abdominal Aortic Aneurysms: A Single-Center Experience with Midterm Results
Comparison between Open and Endovascular Repair for the Treatment of Juxtarenal Abdominal Aortic Aneurysms: A Single-Center Experience with Midterm Results
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DOI：
10.1016/j.avsg.2016.08.045
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发表时间：
2017-05-01
影响因子：
1.5
通讯作者：
Shukuzawa, Kota
中科院分区：
文献类型：
--
作者：
Maeda, Koji;Ohki, Takao;Shukuzawa, Kota
背景资料：为了评价近肾腹主动脉瘤（JAAA）的最佳治疗方法，我们比较了开放手术修复（OSR）与使用各种开孔型和通气管EVARs.Methods的主动脉腔内修复术（EVAR）的结局：我们回顾性评价了152例JAAA的总生存率、动脉粥样硬化相关死亡、再介入和肾功能损害，排除了主动脉夹层和破裂病例。考克斯模型用于评估生存率和评估术后透析率。结果：分别在81例和71例患者中进行了OSR和EVAR。腹主动脉瘤腔内修复术组的平均年龄显著更高（总体，74.5岁; OSR，71岁;腹主动脉瘤腔内修复术; 77岁）。腹主动脉瘤腔内修复术组术前血清肌酐水平较高、脑血管疾病和慢性阻塞性肺疾病更常见。OSR组的平均手术时间、住院时间和围手术期失血量显著更长（P < 0.001）。总体30天死亡率为1.9%，两组之间无统计学差异。腹主动脉瘤腔内修复术组的再次介入率显著较高（P = 0.01）。1年、3年、5年和7年的总生存率分别为97.4%、91.6%、86.3%和82.9%，组间无显著差异。腹主动脉瘤腔内修复术的死亡率与术后肌酐超过3.0 mg/dL相关，OSR后的术后透析与手术时间和出血量相关。结论：OSR和腹主动脉瘤腔内修复术的结局可接受。然而，腹主动脉瘤腔内修复术后更频繁地需要再次介入。在高风险患者中，OSR似乎是JAAA最合适的一线治疗;然而，腹主动脉瘤腔内修复术可能是高风险患者的替代选择。
Background: To evaluate the optimal treatment for juxtarenal abdominal aortic aneurysm (JAAA), we compared the outcomes of open surgical repair (OSR) with endovascular aortic repair (EVAR) using a variety of fenestrated and snorkel EVARs.Methods: We evaluated overall survival, aneurysm-related death, reintervention, and renal impairment in 152 JAAAs retrospectively, excluding cases of aortic dissection and rupture. Cox models were used to assess survival and assessed postoperative dialysis rates following surgery.Results: OSR and EVAR were performed in 81 and 71 patients, respectively. The mean age was significantly higher in the EVAR group (overall, 74.5 years; OSR, 71 years; and EVAR; 77 years). High preoperative serum creatinine levels, cerebrovascular disease, and chronic obstructive pulmonary disease were more prevalent in the EVAR group. Mean operative time, hospital stay, and perioperative blood loss were significantly greater in the OSR group (P < 0.001 for all). The overall 30-day mortality was 1.9% with no statistical difference between 2 groups. The reintervention rate was significantly higher in the EVAR group (P = 0.01). Overall survival rates at 1, 3, 5, and 7 years were 97.4%, 91.6%, 86.3%, and 82.9%, respectively, with no significant difference between groups. Mortality in EVAR was associated with over 3.0 mg/dL of postoperative creatinine, and postoperative dialysis following OSR was associated with operative time and volume of bleeding.Conclusions: Acceptable outcomes were observed with OSR and EVAR. However, reintervention was more frequently required following EVAR. OSR appears to be the most appropriate first-line treatment for JAAA in good-risk patients; however, EVAR may represent an alternative option in high-risk patients.