对于未成功的非感染性大动脉内脏移植的外科探索的长期结果
David J Liesker1, Guus W van Lammeren1, Erik Scholten2
1Department of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
Annals of vascular surgery
|February 15, 2026
概括
失败的内血管大动脉修复 (EVAR) 的开放外科探索是为特定患者提供可行的治疗方法. 选择性扩张提供了优秀的长期存活率和较低的并发症率,使其成为内血管修复失败时的持久选择.
科学领域:
- 血管外科 血管外科
- 内血管外科 血管内血管外科
- 外科手术的结果
背景情况:
- 内血管大动脉修复 (EVAR) 是对大动脉动脉瘤的常见治疗方法.
- EVAR的失败,特别是1a型内泄漏,可能需要进行开放式手术.
- 在EVAR失败后开放式实验的长期结果没有得到充分的证据.
研究的目的:
- 为了研究患者的短期和长期结果,接受了不成功的,非感染的大动脉内移植的开放外科探索.
- 为了比较选择性和急性解剖手术之间的结果.
主要方法:
- 对那些经历了未成功的红内EVAR开放式解释的患者进行了回顾性研究.
- 收集的数据包括基线特征,初始EVAR细节,解释程序和结果.
- 主要终点:长期死亡率. 二级终点:30天不良事件. 使用了卡普兰-梅尔生存曲线.
主要成果:
- 包括52名患者 (41名选择性,11名急性).
- 1a型内孔漏洞是扩张的主要指示 (88.5%).
- 30天死亡率为2.4% (可选) 与18.2% (急性) 相比. 5年生存率为95% (选择性) 与58% (急性) 相比. 5年后不需要重新干预的情况为90% (可选) 和85% (急性).
结论:
- 失败的EVAR的开放式探索是一种可行的程序,在选定的患者中具有良好的结果.
- 选择性实验证明了很好的生存率和低的并发症率.
- 及时识别EVAR故障和患者优化对于成功的结果至关重要.
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