Endovascular versus open repair of ruptured abdominal aortic aneurysms with hostile neck anatomy.

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE Journal of Vascular Surgery Pub Date : 2024-10-16 DOI:10.1016/j.jvs.2024.10.010
Grayson S Pitcher, Indrani Sen, Karina S Newhall, Michael C Stoner, Bernardo C Mendes, Doran Mix
{"title":"Endovascular versus open repair of ruptured abdominal aortic aneurysms with hostile neck anatomy.","authors":"Grayson S Pitcher, Indrani Sen, Karina S Newhall, Michael C Stoner, Bernardo C Mendes, Doran Mix","doi":"10.1016/j.jvs.2024.10.010","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Aneurysm neck anatomy in ruptured abdominal aortic aneurysms (rAAAs) is often complex, limiting the feasibility of endovascular repair (EVAR). The objective of this study was to compare the outcomes of EVAR and open surgical repair (OSR) for treatment of rAAAs in patients with hostile neck anatomy (HNA). The secondary aim was to review the clinical characteristics and anatomic risk factors predictive of mortality.</p><p><strong>Methods: </strong>A multi-center retrospective review was performed to identify patients with rAAAs and HNA between 2004 and 2021. HNA was defined as infrarenal aortic neck diameter >28 mm, infrarenal neck length <15 mm or angulation >60 degrees. The primary end point was 30-day all-cause mortality. Secondary end points included 90-day, 1-year and 5-year mortality. Preoperative computed tomography was analyzed using an Aquarius workstation. The Kaplan-Meier method was used to estimate survival, and univariate and multivariate Cox proportional hazard regression analysis was used to assess variables that influenced survival.</p><p><strong>Results: </strong>137 patients with rAAAs and HNA underwent infrarenal EVAR or OSR. Overall mean age was 74 ± 10 years and 72% were male. 85 patients (62%) underwent infrarenal EVAR and 52 (38%) underwent OSR. Mean aneurysm size at the time of rupture was 86 ± 22 mm. Patients who underwent OSR were more likely to present with a higher Garland preoperative risk score (P = .05), have a lower pH (P < .001), lower SBP (P < .001) and higher lactate (P = .005). Patients with an infrarenal neck length <15 mm were more likely to undergo OSR (EVAR 64% vs. OSR 87%, P = .004) and patients with an infrarenal neck angle >60 degrees were more likely to undergo EVAR (60% vs. 39%, P = .01). EVAR was associated with lower 30-day (17% vs. 27%; OR 0.6; 95% CI, 0.3-1.2; P = .14) and 90-day (22% vs. 33%; HR 0.6; 95% CI, 0.3-1.2; P = .17) all-cause mortality, however, this was not statistically significant. The overall median follow-up time was 19 (2-66) months. 1-year survival for EVAR and OSR were 75% and 64% (Log-rank P = .14) and 5-year survival for EVAR and OSR were 65% and 55% (Log-rank P = .28). Hemoglobin (P = .009), increasing calcification score (P = .002) and infrarenal neck length <10 mm (P = .01) were associated with all-cause mortality at 30-days for EVAR on multivariate Cox regression analysis. Lactate (P <.001) was the only variable associated with all-cause mortality at 30-days for OSR on multivariate Cox analysis.</p><p><strong>Conclusion: </strong>Early and long-term survival favored EVAR in comparison to OSR in patients with rAAAs and HNA, however, this was not statistically significant. Calcification of the infrarenal neck and neck length <10 mm were associated with increased 30-day mortality for EVAR while no anatomic variables were specifically associated with 30-day mortality for OSR.</p>","PeriodicalId":17475,"journal":{"name":"Journal of Vascular Surgery","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Vascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jvs.2024.10.010","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: Aneurysm neck anatomy in ruptured abdominal aortic aneurysms (rAAAs) is often complex, limiting the feasibility of endovascular repair (EVAR). The objective of this study was to compare the outcomes of EVAR and open surgical repair (OSR) for treatment of rAAAs in patients with hostile neck anatomy (HNA). The secondary aim was to review the clinical characteristics and anatomic risk factors predictive of mortality.

Methods: A multi-center retrospective review was performed to identify patients with rAAAs and HNA between 2004 and 2021. HNA was defined as infrarenal aortic neck diameter >28 mm, infrarenal neck length <15 mm or angulation >60 degrees. The primary end point was 30-day all-cause mortality. Secondary end points included 90-day, 1-year and 5-year mortality. Preoperative computed tomography was analyzed using an Aquarius workstation. The Kaplan-Meier method was used to estimate survival, and univariate and multivariate Cox proportional hazard regression analysis was used to assess variables that influenced survival.

Results: 137 patients with rAAAs and HNA underwent infrarenal EVAR or OSR. Overall mean age was 74 ± 10 years and 72% were male. 85 patients (62%) underwent infrarenal EVAR and 52 (38%) underwent OSR. Mean aneurysm size at the time of rupture was 86 ± 22 mm. Patients who underwent OSR were more likely to present with a higher Garland preoperative risk score (P = .05), have a lower pH (P < .001), lower SBP (P < .001) and higher lactate (P = .005). Patients with an infrarenal neck length <15 mm were more likely to undergo OSR (EVAR 64% vs. OSR 87%, P = .004) and patients with an infrarenal neck angle >60 degrees were more likely to undergo EVAR (60% vs. 39%, P = .01). EVAR was associated with lower 30-day (17% vs. 27%; OR 0.6; 95% CI, 0.3-1.2; P = .14) and 90-day (22% vs. 33%; HR 0.6; 95% CI, 0.3-1.2; P = .17) all-cause mortality, however, this was not statistically significant. The overall median follow-up time was 19 (2-66) months. 1-year survival for EVAR and OSR were 75% and 64% (Log-rank P = .14) and 5-year survival for EVAR and OSR were 65% and 55% (Log-rank P = .28). Hemoglobin (P = .009), increasing calcification score (P = .002) and infrarenal neck length <10 mm (P = .01) were associated with all-cause mortality at 30-days for EVAR on multivariate Cox regression analysis. Lactate (P <.001) was the only variable associated with all-cause mortality at 30-days for OSR on multivariate Cox analysis.

Conclusion: Early and long-term survival favored EVAR in comparison to OSR in patients with rAAAs and HNA, however, this was not statistically significant. Calcification of the infrarenal neck and neck length <10 mm were associated with increased 30-day mortality for EVAR while no anatomic variables were specifically associated with 30-day mortality for OSR.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
对颈部解剖结构不佳的破裂腹主动脉瘤进行血管内修复与开放式修复。
目的:腹主动脉瘤(rAAA)破裂后的动脉瘤颈解剖结构往往很复杂,限制了血管内修复(EVAR)的可行性。本研究的目的是比较EVAR和开放手术修复(OSR)治疗具有敌对颈部解剖结构(HNA)的rAAA患者的效果。次要目的是回顾预测死亡率的临床特征和解剖风险因素:我们进行了一项多中心回顾性研究,以确定2004年至2021年间患有rAAA和HNA的患者。HNA定义为肾下主动脉颈直径大于28毫米,肾下主动脉颈长度为60度。主要终点是 30 天全因死亡率。次要终点包括 90 天、1 年和 5 年死亡率。术前计算机断层扫描使用 Aquarius 工作站进行分析。采用卡普兰-梅耶法估算存活率,并采用单变量和多变量考克斯比例危险回归分析评估影响存活率的变量:137例rAAA和HNA患者接受了肾下EVAR或OSR手术。总平均年龄为 74 ± 10 岁,72% 为男性。85名患者(62%)接受了肾下EVAR,52名患者(38%)接受了OSR。动脉瘤破裂时的平均大小为(86 ± 22)毫米。接受OSR的患者术前Garland风险评分更高(P = .05),pH值更低(P < .001),SBP更低(P < .001),乳酸更高(P = .005)。肾动脉颈下长度为 60 度的患者更有可能接受 EVAR(60% 对 39%,P = .01)。EVAR与较低的30天(17% vs. 27%;OR 0.6;95% CI,0.3-1.2;P = .14)和90天(22% vs. 33%;HR 0.6;95% CI,0.3-1.2;P = .17)全因死亡率相关,但无统计学意义。总体中位随访时间为 19 (2-66) 个月。EVAR和OSR的1年存活率分别为75%和64%(Log-rank P = .14),EVAR和OSR的5年存活率分别为65%和55%(Log-rank P = .28)。血红蛋白(P = .009)、钙化评分增加(P = .002)和肾下颈长度 结论:与OSR相比,EVAR更有利于rAAA和HNA患者的早期和长期生存,但这并不具有统计学意义。肾动脉下颈部钙化和颈部长度
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
7.70
自引率
18.60%
发文量
1469
审稿时长
54 days
期刊介绍: Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.
期刊最新文献
A Systematic Review to Examine the Impact of Socioeconomic Status on Revascularization for PAD, Carotid Artery Surgery and Aortic Aneurysm Repair Outcomes in the United States. French Multicentric Registry on LUMINOR Drug-Eluting Balloon for Superficial Femoral and Popliteal Arteries. Outcomes of Prosthetic and Biological Grafts Compared to Arm Vein Grafts in Patients with Chronic Limb Threatening Ischemia. Whole aorta imaging shows increased risk for thoracic aortic aneurysms and dilatations in relatives of abdominal aortic aneurysm patients. Long-Term Outcomes of Elective Endovascular versus Open Repair of Popliteal Artery Aneurysms in the VISION Database.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1