Implications of concomitant hypogastric artery embolization with endovascular repair of infrarenal abdominal aortic aneurysms
Implications of concomitant hypogastric artery embolization with endovascular repair of infrarenal abdominal aortic aneurysms
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腹下动脉栓塞联合肾下腹主动脉瘤血管内修复术的意义
DOI：
10.1016/j.jvs.2016.10.124
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发表时间：
2017
影响因子：
4.3
通讯作者：
S. Toursavadkohi
中科院分区：
文献类型：
--
作者：
B. Farivar;Richa Kalsi;C. Drucker;Carly B. Goldstein;R. Sarkar;S. Toursavadkohi
腹下动脉栓塞（HAE）与缺血性并发症的显著风险相关。我们评估了HAE对腹主动脉瘤腔内修复术（EVAR）肾下abdominal aortic aneurysm.MethodsWe的30天的结果查询美国外科医师学会国家外科手术质量改进计划数据库从2011年到2014年，以确定和比较临床特征，手术细节，30天的结果腹主动脉瘤腔内修复术与伴随HAE与腹主动脉瘤腔内修复术（HAE +腹主动脉瘤腔内修复术）。进行多变量分析，以确定与HAE + EVAR.ResultsIn的患者中观察到的重大并发症的发展相关的术前和术中因素，在一个队列的5881例患者，387（6.6%）进行HAE + EVAR。与腹主动脉瘤腔内修复术相比，HAE +腹主动脉瘤腔内修复术后缺血性结肠炎（2.6% vs 0.9%; P= 0.002）、需要透析的肾衰竭（2.8% vs 1%;P= 0.001）、肺炎（2.6% vs 1.3%;P= 0.039）和围手术期输血（17% vs 13%;P= 0.024）的发生率较高。30天血栓栓塞事件、卒中、心肌梗死、下肢缺血、再手术和再入院率无显著差异（P> 0.05）。HAE +腹主动脉瘤腔内修复术患者的30天死亡率为4.1%，腹主动脉瘤腔内修复术患者为2.5%（P= 0.044）。HAE与结肠缺血（校正比值比，2.98; 95%置信区间，1.44-6.14;P= 0.003）和需要透析的肾衰竭（校正比值比，2.22; 95%置信区间，1.09-4.53;P= 0.029）的风险增加独立相关。然而，HAE不是死亡率的独立预测因子。HAE +腹主动脉瘤腔内修复术后的平均住院时间为4 ± 8.5天，腹主动脉瘤腔内修复术后的平均住院时间为3.3 ± 5.9天（P= .001）。结论HAE+腹主动脉瘤腔内修复术伴随的住院时间更长且更复杂。缺血性结肠炎是腹主动脉瘤腔内修复术的罕见并发症。HAE会增加缺血性结肠炎和需要透析的肾衰竭的风险。本研究强调了腹主动脉瘤腔内修复术中腹下动脉保护的重要性。
ObjectiveHypogastric artery embolization (HAE) is associated with significant risk of ischemic complications. We assessed the impact of HAE on 30-day outcomes of endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysms.MethodsWe queried the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2014 to identify and to compare clinical features, operative details, and 30-day outcomes of EVAR with those of concomitant HAE with EVAR (HAE + EVAR). Multivariate analysis was performed to determine preoperative and intraoperative factors associated with development of significant complications observed in patients with HAE + EVAR.ResultsIn a cohort of 5881 patients, 387 (6.6%) underwent HAE + EVAR. Compared with EVAR, a higher incidence of ischemic colitis (2.6% vs 0.9%;P= .002), renal failure requiring dialysis (2.8% vs 1%;P= .001), pneumonia (2.6% vs 1.3%;P= .039), and perioperative blood transfusion (17% vs 13%;P= .024) was noted after HAE + EVAR. Thirty-day thromboembolic events, strokes, myocardial infarction, lower extremity ischemia, reoperation, and readmission rates were not significantly different (P> .05). Mortality at 30 days in HAE + EVAR patients was 4.1% compared with 2.5% with EVAR (P= .044). HAE was independently associated with increased risk of colonic ischemia (adjusted odds ratio, 2.98; 95% confidence interval, 1.44-6.14;P= .003) and renal failure requiring dialysis (adjusted odds ratio, 2.22; 95% confidence interval, 1.09-4.53;P= .029). However, HAE was not an independent predictor of mortality. Average length of hospital stay was 4 ± 8.5 days after HAE + EVAR vs 3.3 ± 5.9 days after EVAR (P= .001).ConclusionsConcomitant HAE with EVAR is associated with longer and more complicated hospital stays. Ischemic colitis is a rare complication of EVAR. HAE increases the risk of ischemic colitis and renal failure requiring dialysis. This study highlights the importance of hypogastric artery preservation during EVAR.
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。
影响因子：
4.3
作者：
Ultee,KlaasHJ;Zettervall,SaraL;Soden,PeterA;Darling,Jeremy;Siracuse,JeffreyJ;Alef,MatthewJ;Verhagen,HenceJM;Schermerhorn,MarcL;VascularStudyGroupofNewEngland
通讯作者：
VascularStudyGroupofNewEngland