Risk factors and short and medium-term survival after open and endovascular repair of abdominal aortic aneurysms

Abstract Background Infrarenal abdominal aortic aneurysms (AAA) are responsible for high rates of rupture-associated morbidity and mortality and can be treated by open or endovascular surgery. Objectives To analyze risk factors and survival associated with surgical and endovascular AAA treatment methods. Methods A retrospective, longitudinal study involving 41 patients who underwent endovascular or open AAA repair, whether elective or emergency, over a 48-month period, with analysis of preoperative comorbidities, 30-day and 1-year survival, in-hospital mortality, length of hospital stay, transfusion of blood products, duration of surgery, and development of acute kidney failure. Inferential statistics and survival analysis considered a 95% CI and p < 0.05 as significant. Results Twelve of the 41 patients were treated with open surgery and 29 with endovascular techniques. The majority were male (75%), with an average age of 71 (range: 56 – 90 years). There were no differences in demographic or risk factors between the groups. Overall survival rates for open and endovascular repair were different for both 30 days (37 vs. 72%, p = 0.01) and 360 days (37 vs. 67%, p = 0.01). However, survival rates in elective cases were similar at 30 days (71 vs. 76%, p = 0.44) and 360 days (both 71%, p = 0.34). Endovascular repair showed shorter length of hospital stay (3.0 vs. 4.4 days; p = 0.02) and duration of surgery (111 vs. 163 min; p < 0.01) compared to open repair. Conclusions There was no difference in short- or medium-term survival of AAA patients treated electively with endovascular or open surgery. Hospital stays and duration of surgery were both shorter with minimally invasive treatment.

背景 肾下型腹主动脉瘤（Infrarenal Abdominal Aortic Aneurysms, AAA）可引发极高的破裂相关发病率与死亡率，临床可通过开放手术或血管腔内手术进行治疗。
研究目的 分析与腹主动脉瘤手术及血管腔内治疗方式相关的危险因素及生存预后情况。
方法 本研究为回顾性纵向研究，纳入48个月内接受择期或急诊腹主动脉瘤开放修复或血管腔内修复的41例患者，对术前合并症、术后30天及1年生存率、住院死亡率、住院时长、血液制品输注情况、手术时长以及急性肾衰竭发生情况进行分析。采用推断统计与生存分析方法，以95%置信区间（CI）、P<0.05作为显著性判断标准。
结果 41例患者中，12例接受开放手术治疗，29例接受血管腔内技术治疗。受试者以男性为主（75%），平均年龄71岁（范围：56~90岁）。两组患者的人口学特征与危险因素均无显著差异。开放修复与血管腔内修复患者的30天生存率（37% vs. 72%，P=0.01）及360天生存率（37% vs. 67%，P=0.01）均存在显著差异。但在择期手术病例中，两组患者30天生存率（71% vs. 76%，P=0.44）与360天生存率（均为71%，P=0.34）均无显著差异。与开放修复相比，血管腔内修复患者的住院时长更短（3.0天 vs. 4.4天；P=0.02），手术时长也更短（111 min vs. 163 min；P<0.01）。
结论 接受择期治疗的腹主动脉瘤患者，其短期及中期生存率在血管腔内治疗与开放手术治疗之间无显著差异。微创治疗的住院时长与手术时长均更短。