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复杂腹腔大动脉动脉瘤的开放和内血管修复的比较

Sai Divya Yadavalli¹, Vinamr Rastogi², Ambar Mehta³

¹Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Journal of vascular surgery

|October 20, 2024

概括

血管内修复 (FEVAR) 在男性中为复杂腹腔大动脉动脉瘤 (cAAA) 提供较低的术后死亡率,但在女性中显示出类似的短期结果. 从长远来看,女性的FEVAR导致了较高的再干预和死亡率,而不是开放修复 (OAR).

科学领域:

血管外科血管外科
血管内干预血管内干预
大动脉动脉瘤修复修复

背景情况:

复杂的腹腔大动脉瘤 (cAAA) 需要仔细考虑修复策略.
人们越来越多地认识到大动脉动脉瘤修复后结果的性别差异.
内血管动脉瘤修复 (EVAR) 和开放式手术修复 (OSR) 是主要的治疗选择.

研究的目的:

为了比较外科手术前和5年内cAAAs的封闭内血管大动脉修复 (FEVAR) 与开放修复 (OAR) 的结果.
为了分别分析男性和女性的结果,以确定性别特异性的差异.
为临床决策和对cAAA治疗的未来研究方向提供信息.

主要方法:

来自VISION注册表 (2014-2019) 的可选cAAA维修的分析 (2014-2019).
根据性别和倾向性得分对患者的分层对OAR与FEVAR进行匹配.
使用回归模型评估术后和5年后的结果 (死亡率,再干预,破裂).

主要成果:

FEVAR在男性中显示了较低的术后死亡率,但5年后的结果与OAR相似,再干预率更高.
在女性中,FEVAR和OAR显示了类似的术后死亡率.
在5年后,女性的FEVAR与较高的死亡率和再干预率有关,与OAR相比.

结论:

FEVAR为男性cAAA修复提供了短期的好处,但长期的好处减少了.
女性的发烧没有经手术期间的优势,并且与更糟糕的长期结果 (更高的死亡率和重新干预) 有关.
需要进一步的研究来理解和解决FEVAR结果中的性别差异,建议对女性进行谨慎的患者选择.

关键词:

腹腔大动脉动脉瘤腹腔大动脉动脉瘤腹腔大动脉动脉瘤修复血管内修复血管内修复窗口内血管大动脉修复开放复杂的腹腔大动脉动脉瘤修复

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