医学
危险系数
置信区间
外科
单变量分析
前瞻性队列研究
支架
血液透析
内科学
多元分析
作者
J. Marzelle,Émilie Presles,J.-P. Becquemin
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2015-01-01
卷期号:261 (1): 197-206
被引量:103
标识
DOI:10.1097/sla.0000000000000612
摘要
In Brief Objective: To present results and to identify predictive factors of early outcome after fenestrated and/or branched endovascular repair (f/b-EVAR) for complex aortic aneurysms, abdominal (AAA) and thoracoabdominal (TAAA). Background: Feasibility of f/b-EVAR for complex aneurysms is now established, but little is known about which patients will benefit from this technique. Methods: Univariate and multivariate analysis of preoperative and intraoperative factors on postoperative mortality and complications was performed on 268 patients (group 1: juxta- and pararenal AAA; group 2: suprarenal and TAAA IV; group 3: TAAA I, II, III) enrolled in a prospective multicenter trial of f/b-EVAR. Results: Thirty-day mortality, in-hospital mortality (IM), and combined mortality and severe complications (CMSC) rates were 6.7%, 10.1%, and 22.0%, respectively. Group belonging (2 or 3 vs 1) was the only preoperative predictive factor of CMSC [hazard ratio (HR) = 2.10; 95% confidence interval (CI): 1.26–3.48; P = 0.0043]. Occurrence of a technical complication and duration of intervention significantly influenced both IM (HR = 4.39; 95% CI: 2.05–9.38; P = 0.0001) and CMSC (HR = 3.07; 95% CI: 1.84–5.11; P < 0.0001). Postoperative events associated with increased IM were spinal cord ischemia (HR = 9.46; 95% CI: 3.98–22.47; P < 0.0001), hemodialysis (HR = 27.44; 95% CI: 12.63–59.61; P < 0.0001), and reintervention (HR = 4.45; 95% CI: 2.03–9.73; P = 0.0002). Conclusions: Although promising, f/b-EVAR still carries a significant rate of mortality and complications, mostly related to the complexity of the procedure. In these complex cases, new strategies should be investigated to improve outcomes. Outcomes of fenestrated and/or branched endovascular repair in complex aneurysms were assessed in a prospective multicenter study of 268 patients. Mortality, combined mortality and complications, renal function impairment, and spinal cord ischemia were linked to the extent of the aneurysm and to the duration of the repair.
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