Faktori koji utiču na rane rezultate elektivnog hirurškog lečenja aneurizme abdominalne aorte
Factors affecting early results after elective open repair of abdominal aortic aneurysms
Author
Maksić, MilankoMentor
Davidović, LazarCommittee members
Kostić, DušanMarković, Dragan
Maksimović, Živan
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Show full item recordAbstract
Uvod. Cilj ovog rada je prikaz faktora koji utiču na rane rezltate otvorenog hirurškog
lečenja (OHL) aneurizmi abdominalne aorte (AAA).
Metod. Istraživanje je sprovedeno u vidu prospektivne studije na 450 pacijenata
podvrgnutih elektivnom OHL AAA na Klinici za vaskularnu i endovaskularnu hirurgiju
KCS u Beogradu u period januar 2013-septembr 2014 godine.
Rezultati. Smrtni ishod zabeležen je kod sedam (1.55%) bolesnika u prvih 30
postoperativnih dana. Uzroci smrtnog ishoda bili su: nekontrolisano krvarenje-1; akutni
infarkt miokarda-1; ishemijski kolitis-2, MOFS-2, sepsa-1. Koronarna bolest (OR:3.89;
CI:0.85-17.7; p=0.0058), postoperativni akutni infarkt miokarda (OR:29.9; CI:2.56-
334.95; p=0.0053), hronična bubrežna slabost (OR: 7.5; CI 1.35-8.5; p=0.0073),
ishemijski kolitis (OR:88.2; CI:4.77-1629.69; p=0.0026), okluzija obe hipogastrične
arterije uz nemogućnost da se bar jedna prezervira (OR:17.4; CI:1.99-178.33;
p=0.0230), aorto bifemoralna rekonstrukcija (OR:9.06; CI:1.76-46.49; p...=0.016),
značajno perioperativni krvarenje (>2 litra) (OR:7.32; CI:1.31-10.79; p=0.0001),
“hostilni” abdomen (OR:5.25; CI:1.3-21.1; p=0.0055), inflamatorna aneurizma (OR:
13.99; CI:2.88-65.09; p=0.0002), supracelijačno klemovanje aorte (OR:18.7; CI:3.8-
90.6; p=0.0003), prolongirano klemovanje aorte (>60 minuta) (OR:14.25; CI:2.75-64.5;
p=0.0003), intraoperativna hipotenzija (OR:6.61; CI:0.71-61.07; p=0.0545),
prolongirana operacija (>240 minuta) (OR:8.66; CI:0.91-81.56; p=0.0585) i kompletna
dehiscencija laparotomne rane (OR:44.1; CI:3.39-572.78; p=0.0396) povećavaju 30
dnevni mortalitet.Zaključak: Rani moratlitet nakon OHL AAA u centrima sa velikim iskustvom koji
imaju dobro obučene multidisciplinarne timove, može biti veoma nizak. Takozvano
centralizovano OHL može biti adekvatna solucija za pacijetne sa nepovoljnom
anatomijom, odnosno za mladje, nerizične pacijenta sa dugom životnom prognozom.
To assess results of open repair (OR) of AAA in a single high volume centre.
Methods. We analyzed prospectively collected data of 450 patients who underwent
elective OR of AAA at the Clinic for vascular and endovascular surgery of the Serbian
Clinical Centre in the period between January 2013 and September 2014.
Results. Postoperative death occurred in seven patients (1. 55%) during the first 30
postoperative days. The mortality was caused by: uncontrolled bleeding-1,acute
myocardial infarction-1, ischemic colitis-2, MOFS-2, sepsis due to infection and
dehiscence of laparotomy wound -1. Coronary artery disease (OR:3.89; CI:0.85-17.7;
p=0.0058), postoperative acute myoardial infarction (OR:29.9; CI:2.56-334.95;
p=0.0053), chronic renal failure (OR: 7.5; CI 1.35-8.5; p=0.0073), colonic necrosis
(OR:88.2; CI:4.77-1629.69; p=0.0026), occlusion of the both hypogastric arteries an the
inability to preserve at least one hypogastric artery (OR:17.4; CI:1.99-178.33;
p=0.0230), aorto bifemoral r...econstruction (OR:9.06; CI:1.76-46.49; p=0.016),
significant perioperative blleding (>2 liters) (OR:7.32; CI:1.31-10.79; p=0.0001),
hostile abdomen (OR:5.25; CI:1.3-21.1; p=0.0055), inflamatory aneurysm (OR: 13.99;
CI:2.88-65.09; p=0.0002), supraceliac aortic cross clamping (OR:18.7; CI:3.8-90.6;
p=0.0003), prolonged aortic cross clamping (>60 minutes) (OR:14.25; CI:2.75-64.5;
p=0.0003), the intraoperative hypotension (OR:6.61; CI:0.71-61.07; p=0.0545), the
prolonged operation (>240 minutes) (OR:8.66; CI:0.91-81.56; p=0.0585) and complete
dehiscention of the laparotomy (OR:44.1; CI:3.39-572.78; p=0.0396) increased the 30
day mortality in our study.
Conclusions. Early mortality after open repair of AAA in high volume centre might be
very low due to experienced multidisciplinary team. Centralized open aortic surgery
might be solution for effective treatment of patients with unsuitable anatomy or for
young patients with long life expectancy.