Open surgery (OS) versus endovascular aneurysm repair (EVAR) for hemodynamically stable and unstable ruptured abdominal aortic aneurysm (rAAA)
Open surgery (OS) versus endovascular aneurysm repair (EVAR) for hemodynamically stable and unstable ruptured abdominal aortic aneurysm (rAAA)
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开放手术 (OS) 与血管内动脉瘤修复术 (EVAR) 治疗血流动力学稳定和不稳定的破裂腹主动脉瘤 (rAAA)
DOI：
10.1007/s00380-015-0736-3
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发表时间：
2016-08-01
影响因子：
1.5
通讯作者：
Jing, Zaiping
中科院分区：
文献类型：
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作者：
Zhang, Simeng;Feng, Jiaxuan;Jing, Zaiping
动脉瘤腔内修复术（EVAR）是血流动力学（hd）稳定患者破裂腹主动脉瘤（rAAA）的替代治疗。HD不稳定型rAAA患者的治疗仍存在争议。本研究的目的是使用荟萃分析比较腹主动脉瘤腔内修复术和开放手术（OS）在hd-stable和hd-unstable rAAA患者中的结局。本研究的第一部分包括48篇报告腹主动脉瘤腔内修复术（n= 9610）和OS（n= 93867）治疗rAAA的治疗结局的文章。第二部分是本研究的重点，包括48篇文章中的5篇，进一步报告了HD稳定（n= 198）和HD不稳定（n= 185）患者的治疗结果。当观察到组间异质性时，使用随机效应模型计算调整后的比值比（OR），或者在非异质性的情况下，使用固定效应模型分析。在本研究的第一部分中，腹主动脉瘤腔内修复术组的院内死亡率低于OS组（29.9 vs 40.8%; OR 0.59; 95% CI 0.52-0.66;P< 0.01）。在本研究的第二部分，纳入了来自5篇文章的383例患者：152例患者接受腹主动脉瘤腔内修复术治疗，231例患者接受OS治疗。总死亡率为147/383（38.4%），而腹主动脉瘤腔内修复术组和OS组的死亡率分别为25.7%（39/152）和46.8%（108/231）。在HD稳定组中，腹主动脉瘤腔内修复术后的院内死亡率显著低于OS术后[18.9%（18/95）vs 28.2%（29/103）; OR 0.47; 95% CI 0.22-0.97;P= 0.04]。对于HD不稳定型rAAA患者，腹主动脉瘤腔内修复术后的院内死亡率显著低于OS术后[36.8%（21/57）vs 61.7%（79/128）; OR 0.40; 95%CI 0.20-0.79;P< 0.01]。该研究表明，与OS相比，HD不稳定rAAA患者的腹主动脉瘤腔内修复术与结局改善相关。目前可用的出版物有限;因此，该患者亚组的最佳治疗策略仍不清楚。需要进一步的临床研究来提供更详细的数据，如休克指数和长期结果。
Endovascular aneurysm repair (EVAR) is an alternative treatment for ruptured abdominal aortic aneurysms (rAAA) in hemodynamically (hd) stable patients. Treatment for patients with hd-unstable rAAA remains controversial. The aim of this study was to compare the outcomes of EVAR and open surgery (OS) in hd-stable and hd-unstable rAAA patients using meta-analysis. The first part of this study included 48 articles that reported the treatment outcomes of rAAA managed with EVAR (n= 9610) and OS (n= 93867). The second part, which is the focus of this study, included 5 out of 48 articles, which further reported treatment results in hd-stable (n= 198) and hd-unstable (n= 185) patients. When heterogeneity among the groups was observed, a random-effects model was used to calculate the adjusted odds ratios (OR) or in cases of non-heterogeneity, a fixed-effects model analysis was employed. In the first part of this study, the in-hospital mortality rate was found to be lower in the EVAR group than in the OS group (29.9 vs 40.8 %; OR 0.59; 95 % CI 0.52–0.66;P< 0.01). In the second part of this study, 383 patients from 5 articles were included: 152 patients were treated by EVAR, and 231 were treated by OS. The total mortality was 147/383 (38.4 %), while the mortality of the EVAR group and the OS group was 25.7 % (39/152) and 46.8 % (108/231), respectively. In the hd-stable group, the in-hospital mortality after EVAR was significantly lower than that after OS [18.9 % (18/95) vs 28.2 % (29/103); OR 0.47; 95 % CI 0.22–0.97;P= 0.04]. For the hd-unstable rAAA patients, the in-hospital mortality after EVAR was significantly lower than that after OS [36.8 % (21/57) vs 61.7 % (79/128); OR 0.40; 95 % CI 0.20–0.79;P< 0.01]. This study indicated that compared with OS, EVAR in hd-unstable rAAA patients is associated with improved outcomes. Available publications are currently limited; thus, the best treatment strategy for this subgroup of patients remains unclear. Further clinical studies are needed to provide more detailed data, such as the shock index and long-term results.