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在腹腔大动脉动脉瘤修复后的永久透析:系统性审查和元分析

Joshua T Tsai¹, Tiondre Brown², Edmund R Charles³

¹Faculty of Medicine, Imperial College London, London, UK.

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

|November 5, 2025

概括

在腹腔大动脉动脉瘤 (AAA) 修复后,永久性透析的风险对于大多数手术来说都很低. 在EVAR或开放性修复期间的上操纵会增加这种风险,但现代EVAR显示随着时间的推移,透析率降低.

科学领域:

血管外科血管外科
腎臟病學 (nephrology) 是一種醫學專業.
医疗技术评估医疗技术评估

背景情况:

腹腔大动脉瘤 (AAA) 修复是一种常见的手术,具有显著的发病率.
脏并发症,包括需要永久透析,是AAA修复后的一个担忧.
对比内血管动脉瘤修复 (EVAR) 和开放修复对于患者的治疗结果至关重要.

研究的目的:

量化选择性腹腔大动脉瘤 (AAA) 修复后永久性透的风险.
为了比较与内血管动脉瘤修复 (EVAR) 与下和上AAA的开放修复相关的风险.
确定影响透析后AAA修复风险的因素.

主要方法:

从2010年开始发表的研究的系统审查和元分析.
包括初级选择性AAA修复病例,每项研究至少包括100名患者.
按照PRISMA指南进行术后永久透析结果的元回归分析.

主要成果:

在大多数下AAA修复方式中,除了复杂的EVAR外,观察到较低的永久透析率 (<1%).
上操纵 (固定或紧) 与永久透析的风险更高,无论是EVAR还是开放修复.
在透析风险方面,EVAR和用于下或上修复的开放修复之间没有显著的差异.
增加患者年龄,女性性别和更高的对比剂量与增加透析风险有关.
随着时间的推移,永久性透析的发生率下降了,因为内EVAR.

结论:

永久性透析率通常很低 (<1%),用于下AAA修复,复杂的EVAR是例外.
在AAA修复期间接受上操纵的患者面临永久透析的风险增加.
现代的EVAR技术表明透析率随着时间的推移而显著降低.
患者特异性因素 (年龄,性别) 和程序要素 (对比剂量) 影响透析风险.

关键词:

腹腔大动脉动脉瘤腹腔大动脉动脉瘤透析是通过透析进行的.血管内主动脉修复血管内主动脉修复开放性大动脉修复

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