بيانات النشر: Uppsala universitet, Kärlkirurgi
Keele Univ, Royal Stoke Univ Hosp, Dept Vasc Surg, Sch Med, Stoke On Trent, England.
Royal Coll Surgeons England, Clin Effectiveness Unit, London, England.
London Sch Hyg & Trop Med, London, England.
Cambridge Univ Hosp NHS Trust, Cambridge, England.;Univ Cambridge, Dept Surg, Cambridge, England.
Semmelweis Univ, Dept Vasc & Endovasc Surg, Budapest, Hungary.
Univ Helsinki, Dept Vasc Surg, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland.
Australian & New Zealand Soc Vasc Surg, Australasian Vasc Audit, Melbourne, Australia.
Univ Auckland, Waikato Hosp, Hamilton, New Zealand.
Kantonsspital Winterthur, Clin Intervent Radiol & Vasc Surg, Swissvasc Registry, Winterthur, Switzerland.
Norwegian Univ Sci & Technol, St Olavs Hosp, Dept Surg, Sect Vasc Surg, Trondheim, Norway.;Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, Trondheim, Norway.
Landspitalinn Univ Hosp, Dept Vasc Surg, Reykjavik, Iceland.
Asklepios Med Sch, Dept Vasc & Endovasc Surg, Asklepios Clin Wandsbek, Hamburg, Germany.
Aarhus Univ Hosp, Dept Cardiovasc Surg, Div Vasc Surg, Aarhus, Denmark.
نبذة مختصرة : Objective: To determine the peri - operative mortality rate for intact and ruptured abdominal aortic aneurysm (AAA) repair in 10 countries and to compare practice and outcomes over a six year period by age, sex, and geographic location. Methods: This VASCUNET study used prospectively collected data from vascular registries in 10 countries on primary repair of intact and ruptured AAAs undertaken between January 2014 and December 2019. The primary outcome was peri - operative death (30 day or in hospital). Logistic regression models were used to estimate the association between peri - operative death, patient characteristics, and type of procedure. Factors associated with the use of endovascular aortic aneurysm repair (EVAR) were also evaluated. Results: The analysis included 50642 intact and 9453 ruptured AAA repairs. The proportion of EVARs for intact repairs increased from 63.4% in 2014 to 67.3% in 2016 before falling to 62.3% in 2019 (p < .001), but practice varied between countries. EVAR procedures were more common among older patients (p < .001) and men (p < .001). Overall perioperative mortality after intact AAA repair was 1.4% (95% confidence interval [CI] 1.3 - 1.5%) and did not change over time. Mortality rates were stable within countries. Among ruptured AAA repairs, the proportion of EVARs increased from 23.7% in 2014 to 35.2% in 2019 (p < .001). The average aortic diameter was 7.8 cm for men and 7.0 cm for women (p < .001). The overall peri - operative mortality rate was 31.3% (95% CI 30.4 - 32.2%); the rates were 36.0% (95% CI 34.9- 37.2%) for open repair and 19.7% (95% CI 18.2 - 21.3%) for EVAR. This difference and shift to EVAR reduced peri - operative mortality from 32.6% (in 2014) to 28.7% (in 2019). Conclusion: The international practice of intact AAA repair was associated with low mortality rates in registry reported data. There remains variation in the use of EVAR for intact AAAs across countries. Overall perioperative mortality remains high after ruptured AAA, but an increased ...
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