完整的腹腔大动脉动脉瘤的内血管和开放外科修复:18年来单中心研究中的结果,治疗趋势和早期死亡风险因素
Maria Del Pilar Ortega Carrillo1, Oksana Heiser1, Shamsun Naher1
1Department of Vascular and Endovascular Surgery, Munich Aortic Centre, TUM University Hospital, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
Journal of clinical medicine
|February 27, 2026
概括
内血管大动脉修复 (EVAR) 显示,与开放式手术修复 (OSR) 相比,对于完整的腹部大动脉动脉瘤 (iAAA) 的住院死亡率较低. 然而,OSR患者的长期存活率更好.
科学领域:
- 血管外科 血管外科
- 心血管医学 心血管医学
- 手术结果研究研究.
背景情况:
- 内血管大动脉修复 (EVAR) 是完整的腹腔大动脉瘤 (iAAA) 的标准.
- 对于iAAA来说,对EVAR与开放外科修复 (OSR) 的现实数据至关重要.
- 本研究分析了2005-2022年期间的治疗趋势和结果.
研究的目的:
- 对比iAAA的EVAR和OSR之间的住院死亡率.
- 确定医院内死亡的风险因素.
- 评估EVAR和OSR之间的长期生存差异.
主要方法:
- 在1237名iAAA患者 (863名EVAR,374名OSR) 的回顾性单中心研究中.
- 主要结局:住院死亡率.
- 用于时间和风险因素分析的逻辑和对数回归模型.
主要成果:
- 与OSR (3.48%) 相比,EVAR的住院死亡率显著较低 (0.93%).
- 更高的年龄和COPD与死亡率的增加有关.
- EVAR显示了较低的医院死亡风险 (OR 0.16).
- 随着时间的推移,这两种手术的住院死亡率保持稳定.
- 在随访期间,OSR患者的生存时间延长了 (中位数为21个月).
结论:
- 在老年患者中,Evar是iAAA的可靠选择,这些老年患者有不适合OSR的并发症.
- 虽然EVAR降低了即时死亡率,但OSR提供了更好的长期存活率.
- 对iAAA的治疗选择应该平衡即时风险与长期结果.
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