目的:本研究的目的是比较后路手术修复the动脉动脉瘤(PAAs)和血管内排除,分析多中心回顾性研究中的早期和五年结局。
方法:在2010年1月至2023年12月之间,对37个中心接受后路开放修复或血管内修复的所有连续无症状PAA的回顾性维护数据集进行了调查。动脉瘤长度≤60mm被认为是唯一的纳入标准。共纳入605例患者;440PAA(72.7%)通过后路(开放组)治疗,其余165PAA(27.3%)使用覆膜支架治疗(Endo组)。连续数据表示为具有四分位数范围的中位数。评估并比较30天的结果。在跟进时,主要结果是免于再干预,二级通畅,和无截肢生存。次要结果是生存率和原发通畅性。使用对数秩检验比较估计的五年结果。
结果:在30天,在主要发病率方面没有发现差异,死亡率,移植物闭塞,或重新干预。开放组3例(0.7%)出现神经损伤。总体中位随访时间为32.1个月。在五年的随访中,开放组的再干预自由度更高(82.2%vs.68.4%;p=.021)。继发性通畅性无差异(开放组90.7%vs.endo组85.2%;p=.25)或无截肢生存率(开放组99.0%vs.endo组98.4%;p=.73)。后路入路与更好的生存结果相关(84.4%vs.79.4%;p=.050),和初级通畅性(79.8%vs.63.8%;p=0.012)。
结论:通过后入路或腔内隔绝术选择性修复≤60mm的PAA后,早期和长期结果似乎相当。对于那些接受开放手术的人来说,神经损伤可能是一种罕见但潜在的并发症。血管内修复与更多的再干预相关。
OBJECTIVE: The aim of this study was compare elective surgical repair of popliteal artery aneurysms (PAAs) via a posterior approach vs. endovascular exclusion, analysing early and five year outcomes in a multicentre retrospective study.
METHODS: Between January 2010 and December 2023, a retrospectively maintained dataset of all consecutive asymptomatic PAAs that underwent open repair with posterior approach or endovascular repair in 37 centres was investigated. An aneurysm length of ≤ 60 mm was considered the only inclusion criterion. A total of 605 patients were included; 440 PAAs (72.7%) were treated via a posterior approach (open group) and the remaining 165 PAAs (27.3%) were treated using covered stents (Endo group). Continuous data were expressed as median with interquartile range. Thirty day outcomes were assessed and compared. At follow up, primary outcomes were freedom from re-intervention, secondary patency, and amputation free survival. Secondary outcomes were survival and primary patency. Estimated five year outcomes were compared using log rank test.
RESULTS: At 30 days, no differences were found in major morbidity, mortality, graft occlusion, or re-interventions. Three patients (0.7%) in the open group experienced nerve injury. The overall median duration of follow up was 32.1 months. At five year follow up, freedom from re-intervention was higher in the open group (82.2% vs. 68.4%; p = .021). No differences were observed in secondary patency (open group 90.7% vs. endo group 85.2%; p = .25) or amputation free survival (open group 99.0% vs. endo group 98.4%; p = .73). A posterior approach was associated with better survival outcomes (84.4% vs. 79.4%; p = .050), and primary patency (79.8% vs. 63.8%; p = .012).
CONCLUSIONS: Early and long term outcomes following elective repair of PAAs measuring ≤ 60 mm via a posterior approach or endovascular exclusion seem comparable. Nerve injury might be a rare but potential complication for those undergoing open surgery. Endovascular repair is associated with more re-interventions.