VISION 数据库中腘动脉动脉瘤选择性血管内修复与开放性修复的长期疗效对比。

IF 3.9 2区 医学 Q1 PERIPHERAL VASCULAR DISEASE
Keyuree Satam, Anand Brahmandam, Xinyan Zheng, Jialin Mao, Philip Goodney, Cassius Iyad Ochoa Chaar
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引用次数: 0

摘要

导言:选择性腘动脉动脉瘤修补术(PAR)的最佳方式仍存在争议。大多数单中心研究表明,开放式腘动脉瘤修复术(OPAR)比血管内修复术(EPAR)更持久,但缺乏大型随机多中心研究。本研究比较了 VQI-VISION 数据库中 EPAR 和 OPAR 的长期疗效:方法:对血管质量倡议(VQI)医保链接的 VISION 数据库(2010-2019 年)中的外周血管介入治疗和腹股沟下搭桥术的选择性 PAR 进行回顾。对接受 OPAR 和 EPAR 的患者进行倾向匹配,以比较结果:共有 1,159 例 PAA 修复术(65.1% 为开放手术)。EPAR患者年龄较大(77岁对73岁,P结论:就肢体预后而言,即使使用 GSV 作为导管,选择性 EPAR 也是持久的,并且与 OPAR 相当。然而,与血管内治疗相比,使用 GSV 搭桥可提高开放式腘动脉瘤修复术后的存活率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-Term Outcomes of Elective Endovascular versus Open Repair of Popliteal Artery Aneurysms in the VISION Database.

Introduction: The best modality for elective popliteal artery aneurysm repair (PAR) remains controversial. Most single center studies suggest open popliteal aneurysm repair (OPAR) is more durable than endovascular (EPAR), but large randomized multicenter studies are lacking. This study compares long-term outcomes of EPAR and OPAR in the VQI-VISION database.

Methods: Vascular Quality Initiative (VQI) Medicare-linked VISION database (2010-2019) for peripheral vascular interventions and infrainguinal bypass were reviewed for elective PAR. Patients undergoing OPAR and EPAR were propensity-matched to compare outcomes.

Results: There were 1,159 PAA repairs (65.1% open). EPAR patients were older (77 vs 73 years, p<0.001) and more likely to be on P2Y12 inhibitors (26.5% vs 17.0%, p<0.001). After matching, there were 396 patients in each group with similar baseline characteristics. EPAR patients were more likely to be discharged home (87.6% vs 48.5%, p<0.001) and have shorter hospital length-of-stay (1 vs 3 days, p<0.001). Kaplan-Meier curves showed no difference in mortality, reintervention, or major amputation at 1, 3, and 5 years. Cox proportional hazards regression showed no significant association between revascularization strategy and mortality, reintervention, or major amputation. Subgroup analysis of patients undergoing OPAR with great saphenous vein (GSV) bypass compared to EPAR showed that OPAR with GSV bypass was associated with lower mortality without difference in reintervention or major amputation.

Conclusion: Elective EPAR is durable and comparable to OPAR in terms of limb outcomes, even when GSV is used as conduit. However, bypass with GSV was associated with increased survival after open popliteal aneurysm repair compared to endovascular therapy.

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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.
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