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一个15年的单中心经验治疗复杂的大动脉动脉瘤:从开放到复杂的内血管修复过渡

B W C M Warmerdam¹, J Hjortnaes¹, A H G Driessen²

¹Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

|December 27, 2025

概括

复杂的内血管大动脉修复 (EVAR) 在较脆弱的患者中治疗更复杂的动脉瘤. 虽然不那么侵入性,但复杂的EVAR具有风险,特别是对最脆弱的患者,需要精细的患者选择以获得最佳结果.

科学领域:

血管外科血管外科
干预心脏病学干预心脏病学
动脉瘤治疗的方法

背景情况:

复杂的大动脉动脉瘤带来了重大的治疗挑战.
综合内血管大动脉修复 (EVAR) 与开放性手术修复 (OSR) 一起引入,改变了治疗范式.
三级转诊中心管理多种复杂动脉瘤病例.

研究的目的:

分析复杂 (胸腔) 腹腔动脉瘤患者的现实临床形状和手术结果.
评估目前的手术与内血管修复的决策过程.
根据患者的脆弱性和治疗方式来评估结果.

主要方法:

对接受OSR和复杂EVAR (2008-2023) 的患者的回顾性分析.
分析治疗决策的理由和患者的特征.
对被认为不适合OSR的最脆弱复杂EVAR患者的次分析.

主要成果:

包括112名OSR和119名复杂EVAR患者;患者偏好经常指导共享决策.
复杂的EVAR患者具有更高的并发症得分 (查尔森并发症指数).
复杂的OSR有更多的并发症 (31.3%),而复杂的EVAR有更多的再干预 (20.2%).
最脆弱的复杂EVAR患者 (n=47) 的生存率较低,一年死亡率高 (23.8%).

结论:

复杂的EVAR虽然不如OSR复杂,但涉及到显著的风险,特别是对于脆弱的患者.
目前的选择过程识别了复杂EVAR的脆弱患者,但可能无法优化非手术管理候选人.
对患者选择的进一步洞察对于改善复杂动脉瘤治疗结果至关重要.

关键词:

贝瓦尔 (BEVAR) 是一个比瓦尔 (BEVAR) 的名字.发烧,就是发烧.有分支的 EVAR 的 EVAR.复杂的 EVAR 复杂的 EVAR 复杂的复杂的大动脉动脉瘤.有窗户的 EVAR.脆弱脆弱脆弱脆弱脆弱患者的选择患者的选择

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