背景:炎性腹主动脉瘤(IAAA)的血管内修复已成为开放手术的替代方法,但直接比较是有限的。该研究的目的是根据特定的临床特征比较IAAA的血管内修复和开放修复的临床结果。
方法:我们对IAAA开放或血管内修复的患者进行了文献综述。2022年6月,两名研究人员对PubMed报道的论文进行了综述,EMBASE,MEDLINE和Cochrane数据库。字符串“炎性动脉瘤”,使用“腹主动脉瘤”。1972年3月至2021年12月,没有语言限制,筛查报告发表。我们确定了2062例IAAA开放(1586)或血管内修复(476)患者。主要结果是手术死亡率和发病率。次要结果是随访期间的并发症(平均随访48个月)。在进行开放或血管内手术的患者之间进行倾向评分匹配。
结果:在西方国家,在接受血管内修复术的患者中,倾向加权术后死亡率(住院)(1.5%血管内对6%开放)和发病率(6%对18%)显着降低(p<0.0001);动脉瘤较大(直径大于7厘米)的患者,活跃炎症的迹象,和腹膜后动脉瘤破裂在腔内修复术后的预后优于开放手术..20%的患者存在肾积水。当存在活动性炎症的迹象提示肾积水本身急性发作时,大多数患者的肾积水消退(发烧,血管内或开放手术后血清C反应蛋白升高)。尽管进行了相关的类固醇治疗,但血管内手术后没有活动性炎症迹象表明长期肾积水很少消退。在平均48个月的随访中,倾向加权移植物相关并发症在接受腔内修复术的患者中更为常见(20%对8%).对于来自亚洲的患者,开放和腔内修复术后短期和中期结果相似.与主动脉炎相关的IAAA在亚洲更为常见。在西方国家,IAAA通常与动脉粥样硬化有关。
结论:IAAA患者代表异质人群,暗示不同大陆之间的生物差异;保守治疗,应根据患者的临床情况选择血管内或开放手术。血管内修复在有活动性炎症迹象的患者中具有优势,包含IAAA破裂和较大的动脉瘤。肾积水,没有活动性炎症的迹象,与类固醇治疗相关的血管内修复术后很少出现消退。需要进一步的研究来确定血管内修复的长期结果。
BACKGROUND: Endovascular repair of inflammatory abdominal aortic aneurysms (IAAAs) has emerged as an alternative to open surgery, but direct comparisons are limited. The aim of the study was to compare clinical outcomes of endovascular and open repair for IAAA according with specific clinical characteristics.
METHODS: We performed a literature
review of reports describing patients who had open or endovascular repair for IAAA. A literature search was performed in June 2022 by 2 investigators who conducted a
review of papers reported in PubMed, Embase, MEDLINE, and Cochrane Database. The strings \"Inflammatory aneurysm\" and \"Abdominal Aortic Aneurysms\" were used. There was no language restriction and screened reports were published from March 1972 to December 2021. We identified 2,062 patients who had open (1,586) or endovascular repair (476) for IAAA. Primary outcomes were operative mortality and morbidity. Secondary outcomes were complications during follow-up (mean follow-up: 48 months). Propensity score matching was performed between patients who had open or endovascular surgery.
RESULTS: In Western countries, propensity-weighted postoperative mortality (in-hospital) (1.5% endovascular vs. 6% open) and morbidity rates (6% vs. 18%) were significantly lower in patients who had endovascular repair (P < 0.0001); patients with larger aneurysm (more than 7 cm diameter), signs of active inflammation, and retroperitoneal rupture of the aneurysm had better outcomes after endovascular repair than after open surgery. Hydronephrosis was present in 20% of the patients. Hydronephrosis regressed in most patients when signs of active inflammation were present suggesting an acute onset of the hydronephrosis itself (fever, elevated serum C Reactive Protein) either after endovascular or open surgery. Long-standing hydronephrosis as suggested by the absence of signs of active inflammation rarely regressed after endovascular surgery despite associated steroid therapy. During a mean follow-up of 48 months, propensity-weighted graft-related complications were more common in patients who had endovascular repair (20% vs. 8%). For patients from Asia, short-term and medium-term results were similar after open and endovascular repair. IAAAs related with
aortitis were more common in Asia. In Western countries, IAAAs were commonly associated with atherosclerosis.
CONCLUSIONS: Patients with IAAA represent a heterogeneous population, suggesting biological differences from continent to continent; conservative therapy and endovascular or open surgery should be chosen according to the patient clinical condition. Endovascular repair presents advantages in patients with signs of active inflammation and contained rupture of the IAAA and larger aneurysms. Hydronephrosis, without signs of active inflammation, rarely regresses after endovascular repair associated with steroid therapy. Further studies are needed to establish the long-term results of endovascular repair.