Abstract: Complete replacement of open surgical repair for ruptured abdominal aortic aneurysms by endovascular aortic repair        YUE Jia-ning, FANG Gang, GUO Da-qiao, et al.  Department of Vascular Surgery， Zhongshan Hospital；Vascular Surgery Institute of Fudan University, Shanghai 200032，China
Corresponding author：FU Wei-guo，E-mail：yuejianing@gmail.com
Abstract    Objective    To evaluate the feasibility and possibility for replacement of the traditional open surgical repair with endovascular aortic repair in RAAA. Methods    The clinical data of 121 cases of EVAR on RAAA performed from January 2009 to December 2019 in Department of Vascular Surgery， Zhongshan Hospital was analyzed retrospectively. The treatment strategies evolved from“EVAR/OPEN”approach（from January 2009 to March 2014）to“EVAR only”approach（from April 2014 to December 2019）. The outcomes between the two periods were compared. Results    A total  of 121 patients with truly-ruptured AAA was admitted in the ER，among which 29 died preoperatively. And 40 cases（19 EVARs and 21 OPENs）were treated during“EVAR/OPEN”period，and the 30-day mortality rate were 26.3% and 23.8% for EVAR and open repair respectively. Thereafter，during the“EVAR only”period all the 52 cases were treated by EVAR，and the 30-day mortality rate was 23.1%. There was no significant difference between the two periods. There was not any association between any kind of procedure in any kind of hemodynamic status or adherence with the outcomes. Conclusion    The“EVAR only”approach has allowed EVAR to be used in nearly all the ruptured AAA with similar mortality comparing with“EVAR/OPEN”approach.

Key words: abdominal aortic aneurysm, ruptured abdominal aortic aneurysm, endovascular aortic repair, emergency

摘要：

目的    探讨应用腔内修复（EVAR）完全替代开放手术治疗急性腹主动脉瘤的可行性。方法    回顾性分析复旦大学附属中山医院血管外科2009年1月至2019年12月期间收治的121例真性破裂性腹主动脉瘤的病人资料。对比“选择性EVAR（EVAR/Open）”时期（2009年1月至2014年3月）与“完全EVAR（EVAR Only）”时期（2014年4月至2019年12月）的两种治疗策略的疗效。结果    121例真性破裂性腹主动脉瘤病人中，29例于术前放弃手术或死亡。其中，在“EVAR/Open”时期，40例（19例EVAR及21例开放手术）接受外科治疗，EVAR及开放手术后30 d病死率分别为26.3%及23.8%（P=0.94）；而在“EVAR Only”时期共52例全部接受EVAR治疗，术后30 d病死率为23.1%。两个时期病死率差异无统计学意义（P=0.83）。两个时期内均未观察到不同术式在不同术前血流动力学状态及不同瘤体解剖学条件中对病死率有明显的影响。结论    基于所在中心平诊手术经验的“完全EVAR”策略可有效用于几乎所有破裂性腹主动脉瘤的急诊救治，并获得与“选择性EVAR”策略一致的疗效。

关键词: 腹主动脉瘤, 破裂性腹主动脉瘤, 腔内修复, 急诊