瑞士复杂腹主动脉瘤修复术的围手术期死亡率和发病率：Swissvasc 报告。

IF 5.7 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2025-01-01 DOI:10.1016/j.ejvs.2024.06.022

Lorenz Meuli , Yves L. Kaufmann , Thomas Lattmann , Nicolas Attigah , Florian Dick , Edin Mujagic , Dimitrios D. Papazoglou , Salome Weiss , Thomas R. Wyss , Alexander Zimmermann

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引用次数: 0

摘要

目的：复杂腹主动脉瘤（cAAA）是一项临床挑战。本研究旨在评估瑞士无症状腹主动脉瘤患者进行开放式动脉瘤修补术（OAR）和带瓣/带支主动脉内膜修补术（F/BEVAR）的30天死亡率和发病率，以及医院规模的影响：回顾性队列研究使用瑞士国家血管外科登记处 Swissvasc 的数据，包括 2019 年 1 月 1 日至 2022 年 12 月 31 日接受治疗的患者。确定了所有无症状、真正的非感染性 cAAA 患者。主要结果是采用克拉维恩-丁多分类法报告的 30 天死亡率和发病率。经过倾向得分加权后，比较了 OAR 和 F/BEVAR 的结果：在461例患者中，333例接受了OAR手术，128例接受了F/BEVAR手术。30天后，OAR和F/BEVAR的总死亡率分别为3.3%和3.1%（P = .76）。倾向评分加权分析显示，两种方法的发病率相似：F/BEVAR（OR 0.69，95% CI 0.45 - 1.05，p = .055）；肠缺血（OAR 后为 1.8%，F/BEVAR 后为 3.1%，p = .47）和需要透析的肾衰竭（OAR 后为 1.5%，F/BEVAR 后为 5.5%，p = .024）与最高发病率和死亡率相关。发病率较高的特定治疗并发症是 F/BEVAR 术后的腹腔间室综合征和下肢间室综合征。瑞士大多数治疗cAAA的医院总体治疗量较低；在治疗量低的医院中发现了死亡率升高的异常值：结论：在瑞士，OAR和F/BEVAR治疗cAAA的30天死亡率和发病率相当；缺乏集中化也是一个突出问题。导致死亡率的器官并发症是肾衰竭、肠缺血和肢体缺血，尤其是在 F/BEVAR 术后。在专业的大容量中心进行治疗，同时努力减少围手术期肾脏损伤和肠系膜缺血，有可能降低择期 cAAA 治疗的发病率和死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Editor's Choice – Peri-operative Mortality and Morbidity of Complex Abdominal Aortic Aneurysm Repair in Switzerland: A Swissvasc Report

Objective

Complex abdominal aortic aneurysms (cAAA) pose a clinical challenge. The aim of this study was to assess the 30 day mortality and morbidity rates for open aneurysm repair (OAR) and fenestrated or branched endovascular aortic repair (F/B-EVAR), and the effect of hospital volume in patients with asymptomatic cAAA in Switzerland.

Methods

Retrospective, cohort study using data from Switzerland's national registry for vascular surgery, Swissvasc, including patients treated from 1 January 2019 to 31 December 2022. All patients with asymptomatic, true, non-infected cAAA were identified. The primary outcome was 30 day mortality and morbidity rates reported using the Clavien–Dindo classification. Outcomes were compared between OAR and F/B-EVAR after propensity score weighting.

Results

Of the 461 patients identified, 333 underwent OAR and 128 underwent F/B-EVAR for cAAA. At 30 days, the overall mortality rate was 3.3% after OAR and 3.1% after F/B-EVAR (p = .76). Propensity score weighted analysis indicated similar morbidity rates for both approaches: F/B-EVAR (OR 0.69, 95% CI 0.45 – 1.05, p = .055); intestinal ischaemia (1.8% after OAR, 3.1% after F/B-EVAR, p = .47) and renal failure requiring dialysis (1.5% after OAR, 5.5% after F/B-EVAR, p = .024) were associated with highest morbidity and mortality rates. Treatment specific complications with high morbidity were abdominal compartment syndrome and lower limb compartment syndrome following F/B-EVAR. Overall treatment volume was low for most of the hospitals treating cAAA in Switzerland; outliers with increased mortality rates were identified among low volume hospitals.

Conclusion

Comparable 30 day mortality and morbidity rates were found between OAR and F/B-EVAR for cAAA in Switzerland; lack of centralisation was also highlighted. Organ specific complications driving death were renal failure, intestinal ischaemia, and limb ischaemia, specifically after F/B-EVAR. Treatment in specialised high volume centres, alongside efforts to reduce peri-procedural kidney injury and mesenteric ischaemia, offers potential to lower morbidity and mortality rates in elective cAAA treatment.

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.