摘要
欧洲血管外科学会发布了2024版《腹主动脉-髂动脉动脉瘤管理临床实践指南》,对腹主动脉瘤和髂动脉病变的诊疗策略进行了全面而详细的介绍。该指南基于截至2023年8月的最佳证据,依据修改后的欧洲心脏病学学会评分系统制定了160条建议,较2019年版本新增59项全新建议。新版指南针对质量控制、流行病学与诊断筛查、小型腹主动脉瘤管理、腹主动脉瘤择期修复、破裂及症状性腹主动脉瘤管理、复杂腹主动脉瘤管理等方面的重要内容进行了证据总结与分级推荐。该指南对于指导国内血管外科腹主动脉-髂动脉瘤临床工作具有重大借鉴意义,但同时也需注意结合本土患者的实际情况开展个体化诊疗。本文对指南中相关部分进行了解读,供学者们参考讨论。
欧洲血管外科学会(European Society for Vascular Surgery,ESVS)2024版《腹主动脉-髂动脉动脉瘤管理临床实践指南》(以下简称“2024版指南”)由来自12个欧洲国家的16名血管外科主动脉专家及1名血管病理学家组成的指南编写委员会在3年内共同制定。最终指南共由来自15个国家的23名审稿人历经三轮审查后提交,其中包含11名来自ESVS指南指导委员会的成员及12名外部审稿人。通过总结和评估目前最佳的可用证据(参考文献截至2023年8月),并根据修改后的欧洲心脏病学学会(European Society of Cardiology,ESC)评分系
证据等级 | 定义 | 推荐措辞 |
---|---|---|
Ⅰ | 证据和/或共识表明某一治疗或操作是有益/有效的 | 推荐 |
Ⅱ | 关于某一治疗或操作的有益性/有效性存在有争议的证据和/或不同意见 | |
Ⅱa Ⅱb | 证据/意见的权重倾向于有益/有效 | 应该考虑 |
有益性/有效性不太好由证据/意见确定 | 可以考虑 | |
Ⅲ | 证据或共识表明某一治疗或操作无益/无效,在某些情况下可能有弊处 | 不推荐 |
证据等级 | 定义 |
---|---|
A | 数据来自多个随机试验或者随机试验的Meta分析 |
B | 数据来自单个随机试验、大型非随机研究或非随机试验的Meta分析 |
C | 专家共识和/或小型试验、回顾性研究或注册研究 |
与2019年的旧版本相比,2024版指南新增了160项建议,其中59项为全新建议(包括7项Ⅰ级建议),对49项建议进行了重分级或有显著的措辞修改,意义在一定程度上有所变化,仅有52项建议保持不变。这些更新反映了对腹主动脉瘤知识的增长以及该领域技术和医疗水平的快速进展,迫切需要从2019年的指南中更新信息。本文拟对2024版指南中的重要信息进行详细解读,以供学者们参考讨论。
首先,2024版指南重新强调并更新了关于血管外科手术质量控制的内容。推荐的最低年手术量已提高至每个血管外科中心每年至少完成30台标准腹主动脉瘤修复手术(开放手术和血管内修复各不少于15台),并增加了关于复杂腹主动脉瘤修复手术的最低年手术量的共识建
超声仍然是小型腹主动脉瘤诊断和随访的推荐首选方法,但目前尚无法确定使用哪种测量参照点更为合适。关于这一点的背景及不同测量点放置的临床后果,在2024版指南的第3章和去年的一篇系统综
此外,鉴于腹主动脉瘤流行病学的显著变化,主要是其流行率的下降,对筛查的建议是进行彻底的重新评估。在2024版指南本章更新后的第3节中,仍强烈推荐对高风险群体进行筛查(Ⅰ A),但目标群体未像以前那样在建议中定义,而应根据当地条件,如疾病的流行率、预期寿命和医疗体系结构等决定筛查的目标群
关于小型腹主动脉瘤的管理与诊疗在2024版指南中进行了较大改动与补充。在更新的第4章中明确了小型腹主动脉瘤性别特定的监测间
此外,基于对现有证据的全面分析,如之前美国食品药品监督管理局(Food and Drug Administration,FDA)和欧洲药品管理局(European Medicines Agency,EMA)所建议的限制在小型腹主动脉瘤的患者中使用氟喹诺酮类抗生素的意见,2024版指南认为是没有根据
第4节中关于腹主动脉瘤择期修复的指征也进行了重大修订,现已明确不推荐对男性患者直径<55 mm和女性患者直径<50 mm的腹主动脉瘤进行修复。修复可考虑的直径阈值仍维持为男性55 mm、女性50 mm;然而,由于缺乏支持的高质量证据,这些建议已被降
术前评估方面,基于目前CTA分析技术的不断进展与市面上大量后处理软件的迭代更新,2024版指南新增了明确考虑在腹主动脉瘤择期修复术前进行CTA成像并使用后处理软件分析以建立详细的手术计
主动脉瘤腔内修复术(endovascular aneurysm repair,EVAR)的可行性及其早期和长期成功依赖于可靠的基线评估,包括固定和封堵的锚定区主动脉形态学评价,以及适当支架选择的正确测
第5章同时更新了关于腹主动脉瘤择期修复术中肝素使用和静脉血栓预防的部分,新增推荐使用活化凝血时间(activated clotting time,ACT)以测量肝素对个体患者的影响并指导额外的肝素给
鉴于EVAR手术相关的器械失败的报告,2024版指南建议使用经过耐久性验证的器
目前针对腔内修复有越来越多的新器械上市,需要更为谨慎的评估。对于新一代支架而言,建议继续对基于已建立平台的改进器械在前瞻性注册研究中进行长期随
此外,由于缺乏临床相关获益的证据,不建议在EVAR前常规进行侧支血管的预防性栓塞或非选择性动脉瘤囊栓
正如2024版指南第5章所述,EVAR作为大多数患者腹主动脉瘤的首选治疗方式的趋势依然保持,尤其对于有合适解剖学条件及适当预期寿命的患
在破裂及症状性腹主动脉瘤的治疗过程中,由于其效果的不确定性,主动脉球囊阻断用于近端控制的建议被降级(Ⅱb C
近年来新增的RCT和大型队列研究已经证明了EVAR在治疗破裂性腹主动脉瘤中的益处,因此EVAR作为破裂性腹主动脉瘤首选治疗方案的建议依然有效,同时将其证据水平升级为A
针对破裂性腹主动脉瘤开放或腔内修复术后出现的腹间隔综合征,开放减压中使用真空辅助开放腹部闭合系统的建议被升级,并增加了网片牵引的使用推
2024版指南第7章关于腹主动脉瘤修复术后随访的内容进行了全面更新。与围手术期病死率逐渐下降不同,腹主动脉瘤修复术后的远期病死率仍然很高,过去20年中并没有显著改善。最常见的死亡原因是心血管疾病(尤其是缺血性心脏病)、肺癌和肺部疾病。2024版指南仍推荐腹主动脉瘤手术患者应接受术后心血管风险管理包括他汀类药物治疗、抗血小板药物治疗和血压控制(Ⅰ B
此外,近期发布的关键研究促使主动脉移植物和支架移植物感染的治疗建议得到了更新。在存在感染的情况下,应考虑完全移除移植物并进行感染组织清创。首选的动脉移植物感染治疗方法是使用抗感染材料(如自体深静脉、冷冻保存的同种异体移植物或异种心包移植物)进行原位重建,并广泛清创感染组织。与自体重建相比,假体移植物替换的再感染风险更高,而浸渍了银和/或抗生素的假体移植物比标准假体移植物表现更
第7章同时介绍了多项新增和更新的内漏管理建议。EVAR后锚定区不满意但无影像可见内漏的患者可考虑进行干预以改善封闭,主要通过血管腔内方
2024版指南第8章关于复杂腹主动脉瘤的内容进行了显著扩展,以反映自2019年以来的技术进步,涵盖了近肾和旁肾腹主动脉瘤、肾上腹主动脉瘤以及Ⅳ型胸腹主动脉瘤的管理。基于越来越全面的知识体系,包括最近的英国复杂动脉瘤研
更新的章节还包括关于肾功能保护、预防脊髓缺血以及新技术的应用,包括现成的分支设备、医生改良的开窗内支架(physician-modified endograft,PMEG)、并行支架和原位开窗技术等。
此外,关于髂动脉瘤的修复阈值,鉴于其自然病程,考虑其增长速度缓慢且直径<40 mm时破裂风险极低,2024版指南认为将手术直径阈值从2011年ESVS指南中的30 mm提高到2019年ESVS指南中的35 mm,到现在进一步提高到40 mm是合理
关于髂动脉瘤随访间隔的数据有限,最新建议是:对于直径20~25 mm的髂动脉瘤,每3年随访1次;对于直径25~29 mm的髂动脉瘤,每2年随访1次;对于直径≥30 mm的髂动脉瘤,每年随访1次。已知的髂动脉瘤随访最好使用超声进行,对于较大动脉瘤或超声可见度较差的患者,建议使用CT
在2024版指南第11章中,更新了有关炎性腹主动脉瘤诊疗的推荐。CTA能够检测出炎性腹主动脉瘤典型的解剖特征,即外套征(mantle sign);这种特征表现为由慢性炎性细胞和致密的动脉瘤周围纤维化导致的增厚壁层,同时保留后壁,可能会累及邻近结构如十二指肠、输尿管、左肾静脉和下腔静脉。然而,对于如何测量炎性腹主动脉瘤的直径尚无共识,是否应包括增厚的主动脉壁仍存在争议,这使得决定是否需要手术变得复杂。包括主动脉周围炎症或管壁水肿在内的测量方法有可能严重高估直径,从而迫使实际上较小的腹主动脉瘤进行手术修复。由于手术并发症风险增加且破裂风险没有增加,因此2024版指南考虑在确定炎性腹主动脉瘤修复适应证时,不应包括主动脉周围炎症区域或管壁水
最后,第11章还讨论了在腹主动脉瘤环境中共同决策的证据,并提供了其应用的具体建议。应与患者对话讨论腹主动脉瘤筛查、监测和正在考虑修复的大型无症状腹主动脉瘤的管理,促进共同决策。同时建议考虑使用决策支持工具来帮助患者决定是否考虑修复腹主动脉
尽管2024版指南更新并补充了大量关于腹主动脉-髂动脉瘤自2019年以来的研究证据及推荐意见,在此领域仍有很多亟待解决的问题与需补充的研究数据、共识等。2024版指南中引入了2019—2023年间发布的474篇新参考文献,包括16项RCT的初级或次级分析、106项系统综述或Meta分析以及84项基于血管登记册或质量倡议计划的研究。然而,在160项建议中,只有10项(占6%)建议基于A级证据,其中5项为Ⅰ级建议,2项为Ⅲ级建议;高达112项(占70%)建议仅限于C级证据或共识,这反映出主动脉领域的证据整体上仍然较为薄弱,常只能依赖回顾性、单中心的数据,因此许多推荐意见是基于C级证据,更像是专家共识推荐。这类数据的解读面临诸多挑战。单中心报告通常存在发表和确认偏差,而行业参与也可能会带来商业特殊利益,进一步影响数据的客观性。因此,产生无偏、高质量数据在腹主动脉瘤领域成为普遍优先事项。
人工智能技术,如机器学习,具有巨大的潜力来管理、分析和利用大型数据集,从而在医疗保健领域开发应用程序。这包括自动成像分析、诊断、规划和随访。对新型EVAR设备进行连续监测,以便早期检测故障,或许是近期最值得关注的领域。长期来看,笔者预测其影响会更加深远且广泛,因此血管外科医生参与这一领域的持续发展至关重
在近肾、旁肾或Ⅳ型胸腹主动脉瘤的修复指征上,比标准的肾下腹主动脉瘤更不明确。虽然破裂风险被认为相似,但尚未得到充分证明,而手术风险普遍较高。需要更高质量的证据来支持治疗决策。虽然应优先考虑定制的腔内修复解决方案,但这些可能不易获得,off-label方案可能是开放手术之外的唯一选择。这些手术的作用、持久性和特定并发症需要更多证据支持。从长远来看,在择期手术情况下,摆脱耗时且昂贵的定制解决方案也是理想的方向,开发通用且耐用的现货解决方案是有必要的。复杂腹主动脉瘤修复,尤其是使用特制支架移植物的复杂腔内修复的成本效益问题也同样需要进一步分析。需要更多研究来更好地理解f-EVAR报告的长期生存率差的原因。这仅仅是由于患者选择偏差未补偿的研究方法学现象,还是腔内治疗与尚未知的长期不良影响相关,目前还无法得出定论。
此外,虽然中国血管外科领域近10余年的发展中已形成了越来越多高证据级别的腹主动脉-髂动脉瘤相关临床研究结果,但被国际指南纳入的仍然所占比重相对较小。因此在参照2024版指南的同时,应注意结合国内患者的实际情况,开展个体化诊疗流程。未来亟须进一步在此领域开展更多高水平临床试验,以形成更具中国特色的腹主动脉-髂动脉瘤诊疗共识。
作者贡献声明
阚远晴负责整理文献,梳理撰写文章;符伟国负责提炼文献要义,审核文章撰写。
利益冲突
所有作者均声明不存在利益冲突。
参考文献
Antoniou GA, Bastos Gonçalves F, Björck M, et al. Editor's choice-European society for vascular surgery clinical practice guideline development scheme: an overview of evidence quality assessment methods, evidence to decision frameworks, and reporting standards in guideline development[J]. Eur J Vasc Endovasc Surg, 2022, 63(6):791-799. doi:10.1016/j.ejvs.2022.03.014. [百度学术]
Gray WK, Day J, Horrocks M. Editor's choice-volume-outcome relationships in elective abdominal aortic aneurysm surgery: analysis of the UK hospital episodes statistics database for the getting it right first time (GIRFT) programme[J]. Eur J Vasc Endovasc Surg, 2020, 60(4):509-517. doi:10.1016/j.ejvs.2020.07.069. [百度学术]
Kontopodis N, Galanakis N, Akoumianakis E, et al. Editor's choice-systematic review and meta-analysis of the impact of institutional and surgeon procedure volume on outcomes after ruptured abdominal aortic aneurysm repair[J]. Eur J Vasc Endovasc Surg, 2021, 62(3):388-398. doi:10.1016/j.ejvs.2021.06.015. [百度学术]
Sawang M, Paravastu SCV, Liu ZX, et al. The relationship between operative volume and peri-operative mortality after non-elective aortic aneurysm repair in Australia[J]. Eur J Vasc Endovasc Surg, 2020, 60(4):519-530. doi:10.1016/j.ejvs.2020.04.029. [百度学术]
Trenner M, Salvermoser M, Busch A, et al. The effects of minimum caseload requirements on management and outcome in abdominal aortic aneurysm repair[J]. Dtsch Arztebl Int, 2020, 117(48):820-827. doi:10.3238/arztebl.2020.0820. [百度学术]
Maguire SC, Traynor O, Strawbridge J, et al. A systematic review of simulation in open abdominal aortic aneurysm repair[J]. J Vasc Surg, 2020, 71(5):1802-1808. doi:10.1016/j.jvs.2019.10.009. [百度学术]
Bissacco D, Mandigers TJ, Savaré L, et al. Editor's choice - comparison of the reproducibility of ultrasound calliper placement methods in abdominal aortic diameter measurements: a systematic review and meta-analysis of diagnostic test accuracy studies[J]. Eur J Vasc Endovasc Surg, 2023, 66(5):620-631. doi:10.1016/j.ejvs.2023.06.010. [百度学术]
Wanhainen A, Hultgren R, Linné A, et al. Outcome of the Swedish nationwide abdominal aortic aneurysm screening program[J]. Circulation, 2016, 134(16):1141-1148. doi:10.1161/CIRCULATIONAHA.116.022305. [百度学术]
Guirguis-Blake JM, Beil TL, Senger CA, et al. Primary Care Screening for Abdominal Aortic Aneurysm: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet][M]. Rockville (MD): Agency for Healthcare Research and Quality (US), 2019, Report No.:19-05253-EF-1. DOI: 10.1001/jama.2019.17021 [百度学术]
Prendes CF, Gouveia E Melo R, Caldeira D, et al. Editor's choice - systematic review and meta-analysis of contemporary abdominal aortic aneurysm growth rates[J]. Eur J Vasc Endovasc Surg, 2024, 67(1):132-145. doi:10.1016/j.ejvs.2023.09.039. [百度学术]
Rockley M, Radonjic A, LeBlanc D, et al. The futility of surveillance for old and small aneurysms[J]. J Vasc Surg, 2020, 72(1):162-170. doi:10.1016/j.jvs.2019.09.063. [百度学术]
Thorbjørnsen K, Svensjö S, Gilgen NP, et al. Long term outcome of screen detected sub-aneurysmal aortas in 65 year old men: a single scan after five years identifies those at risk of needing AAA repair[J]. Eur J Vasc Endovasc Surg, 2021, 62(3):380-386. doi:10.1016/j.ejvs.2021.05.039. [百度学术]
Brown JP, Wing K, Leyrat C, et al. Association between fluoroquinolone use and hospitalization with aortic aneurysm or aortic dissection[J]. JAMA Cardiol, 2023, 8(9):865-870. doi:10.1001/jamacardio.2023.2418. [百度学术]
Dong YH, Chang CH, Wang JL, et al. Association of infections and use of fluoroquinolones with the risk of aortic aneurysm or aortic dissection[J]. JAMA Intern Med, 2020, 180(12):1587-1595. doi:10.1001/jamainternmed.2020.4192. [百度学术]
Gopalakrishnan C, Bykov K, Fischer MA, et al. Association of fluoroquinolones with the risk of aortic aneurysm or aortic dissection[J]. JAMA Intern Med, 2020, 180(12):1596-1605. doi:10.1001/jamainternmed.2020.4199. [百度学术]
Niebauer S, Niebauer J, Dalman R, et al. Effects of exercise training on vascular markers of disease progression in patients with small abdominal aortic aneurysms[J]. Am J Med, 2021, 134(4):535-541. doi:10.1016/j.amjmed.2020.07.029. [百度学术]
Oliver-Williams C, Sweeting MJ, Jacomelli J, et al. Safety of men with small and medium abdominal aortic aneurysms under surveillance in the NAAASP[J]. Circulation, 2019, 139(11):1371-1380. doi:10.1161/CIRCULATIONAHA.118.036966. [百度学术]
Olson SL, Panthofer AM, Blackwelder W, et al. Role of volume in small abdominal aortic aneurysm surveillance[J]. J Vasc Surg, 2022, 75(4):1260-1267. doi:10.1016/j.jvs.2021.09.046. [百度学术]
Ulug P, Sweeting MJ, von Allmen RS, et al. Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis[J]. Lancet, 2017, 389(10088):2482-2491. doi:10.1016/S0140-6736(17)30639-6. [百度学术]
Chaikof EL, Fillinger MF, Matsumura JS, et al. Identifying and grading factors that modify the outcome of endovascular aortic aneurysm repair[J]. J Vasc Surg, 2002, 35(5):1061-1066. doi:10.1067/mva.2002.123991. [百度学术]
Parker MV, O'Donnell SD, Chang AS, et al. What imaging studies are necessary for abdominal aortic endograft sizing? A prospective blinded study using conventional computed tomography, aortography, and three-dimensional computed tomography[J]. J Vasc Surg, 2005, 41(2):199-205. doi:10.1016/j.jvs.2004.12.010. [百度学术]
Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm[J]. N Engl J Med, 2008, 358(5):494-501. doi:10.1056/nejmct0707524. [百度学术]
Doganer O, Jongkind V, Blankensteijn JD, et al. A standardized bolus of 5 000 IU of heparin does not lead to adequate heparinization during non-cardiac arterial procedures[J]. Ann Vasc Surg, 2021, 71:280-287. doi:10.1016/j.avsg.2020.07.035. [百度学术]
Doganer O, Roosendaal LC, Wiersema AM, et al. Weight based heparin dosage with activated clotting time monitoring leads to adequate and safe anticoagulation in non-cardiac arterial procedures[J]. Ann Vasc Surg, 2022, 84:327-335. doi:10.1016/j.avsg.2022.01.029. [百度学术]
Hoebink M, Roosendaal LC, Wiersema AM, et al. Activated clotting time guided heparinisation during open abdominal aortic aneurysm repair (ACTION-1) - rationale and design of a randomised trial[J]. Eur J Vasc Endovasc Surg, 2023, 65(3):451-452. doi:10.1016/j.ejvs.2023.01.006. [百度学术]
Haykal T, Zayed Y, Kerbage J, et al. Meta-analysis and systematic review of randomized controlled trials assessing the role of thromboprophylaxis after vascular surgery[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(3):767-777. doi:10.1016/j.jvsv.2021.08.019. [百度学术]
Matthay ZA, Flanagan CP, Sanders K, et al. Risk factors for venous thromboembolism after vascular surgery and implications for chemoprophylaxis strategies[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(3):585-593. doi:10.1016/j.jvsv.2021.10.001. [百度学术]
Toth S, Flohr TR, Schubart J, et al. A meta-analysis and systematic review of venous thromboembolism prophylaxis in patients undergoing vascular surgery procedures[J]. J Vasc Surg Venous Lymphat Disord, 2020, 8(5):869-881. doi:10.1016/j.jvsv.2020.03.017. [百度学术]
Falster MO, Garland SK, Jorm LR, et al. Editor's choice - comparison of outcomes for major contemporary endograft devices used for endovascular repair of intact abdominal aortic aneurysms[J]. Eur J Vasc Endovasc Surg, 2023, 65(2):272-280. doi:10.1016/j.ejvs.2022.11.005. [百度学术]
Antoniou GA, Juszczak MT, Nasr H, et al. Prognosis review and time-to-event data meta-analysis of endovascular aneurysm repair outside versus within instructions for use of aortic endograft devices[J]. J Vasc Surg, 2020, 71(4):1415-1431. doi:10.1016/j.jvs.2019.08.247. [百度学术]
Barry IP, Turley LP, Mwipatayi DL, et al. The impact of endograft selection on outcomes following treatment outside of instructions for use (IFU) in endovascular abdominal aortic aneurysm repair (EVAR)[J]. Cureus, 2021, 13(5):e14841. doi:10.7759/cureus.14841. [百度学术]
Campbell B, Wilkinson J, Marlow M, et al. Long-term evidence for new high-risk medical devices[J]. Lancet, 2018, 391(10136):2194-2195. doi:10.1016/S0140-6736(18)30975-9. [百度学术]
Goodney P, Mao J, Columbo J, et al. Use of linked registry claims data for long term surveillance of devices after endovascular abdominal aortic aneurysm repair: observational surveillance study[J]. BMJ, 2022, 379:e071452. doi:10.1136/bmj-2022-071452. [百度学术]
Sillesen H, Debus S, Dick F, et al. Long term evaluation should be an integral part of the clinical implementation of new vascular treatments - an ESVS executive committee position statement[J]. Eur J Vasc Endovasc Surg, 2019, 58(3):315-317. doi:10.1016/j.ejvs.2019.08.009. [百度学术]
Weiss S, Bachofen B, Widmer MK, et al. Long-term results of cryopreserved allografts in aortoiliac graft infections[J]. J Vasc Surg, 2021, 74(1):268-275. doi:10.1016/j.jvs.2020.12.070. [百度学术]
Kontopodis N, Galanakis N, Kiparakis M, et al. Pre-emptive embolization of the aneurysm sac or aortic side branches in endovascular aneurysm repair: meta-analysis and trial sequential analysis of randomized controlled trials[J]. Ann Vasc Surg, 2023, 91:90-107. doi:10.1016/j.avsg.2022.10.027. [百度学术]
Li Q, Hou P. Sac embolization and side branch embolization for preventing type Ⅱ endoleaks after endovascular aneurysm repair: a meta-analysis[J]. J Endovasc Ther, 2020, 27(1):109-116. doi:10.1177/1526602819878411. [百度学术]
Samura M, Morikage N, Otsuka R, et al. Endovascular aneurysm repair with inferior mesenteric artery embolization for preventing type Ⅱ endoleak: a prospective randomized controlled trial[J]. Ann Surg, 2020, 271(2):238-244. doi:10.1097/SLA.0000000000003299. [百度学术]
Zhang H, Yang Y, Kou L, et al. Effectiveness of collateral arteries embolization before endovascular aneurysm repair to prevent type Ⅱ endoleaks: a systematic review and meta-analysis[J]. Vascular, 2022, 30(5):813-824. doi:10.1177/17085381211032764. [百度学术]
Antoniou GA, Antoniou SA, Torella F. Editor's choice- endovascular vs. open repair for abdominal aortic aneurysm: systematic review and meta-analysis of updated peri-operative and long term data of randomised controlled trials[J]. Eur J Vasc Endovasc Surg, 2020, 59(3):385-397. doi:10.1016/j.ejvs.2019.11.030. [百度学术]
Giannopoulos S, Kokkinidis DG, Armstrong EJ. Long-term outcomes of endovascular vs open surgical repair for abdominal aortic aneurysms: a meta-analysis of randomized trials[J]. Cardiovasc Revasc Med, 2020, 21(10):1253-1259. doi:10.1016/j.carrev.2020.02.015. [百度学术]
Yokoyama Y, Kuno T, Takagi H. Meta-analysis of phase-specific survival after elective endovascular versus surgical repair of abdominal aortic aneurysm from randomized controlled trials and propensity score-matched studies[J]. J Vasc Surg, 2020, 72(4):1464-1472. doi:10.1016/j.jvs.2020.03.041. [百度学术]
Bath J, Leite JO, Rahimi M, et al. Contemporary outcomes for ruptured abdominal aortic aneurysms using endovascular balloon control for hypotension[J]. J Vasc Surg, 2018, 67(5):1389-1396. doi:10.1016/j.jvs.2017.09.031. [百度学术]
D'Oria M, Gunnarsson K, Wanhainen A, et al. Long-term survival after repair of ruptured abdominal aortic aneurysms is improving over time: nationwide analysis during twenty-four years in Sweden (1994-2017)[J]. Ann Surg, 2023, 277(3):e670-e677. doi:10.1097/SLA.0000000000005030. [百度学术]
Kontopodis N, Galanakis N, Antoniou SA, et al. Meta-analysis and meta-regression analysis of outcomes of endovascular and open repair for ruptured abdominal aortic aneurysm[J]. Eur J Vasc Endovasc Surg, 2020, 59(3):399-410. doi:10.1016/j.ejvs.2019.12.023. [百度学术]
Salata K, Hussain MA, de Mestral C, et al. Population-based long-term outcomes of open versus endovascular aortic repair of ruptured abdominal aortic aneurysms[J]. J Vasc Surg, 2020, 71(6):1867-1878. doi:10.1016/j.jvs.2019.06.212. [百度学术]
Wang LJ, Locham S, Al-Nouri O, et al. Endovascular repair of ruptured abdominal aortic aneurysm is superior to open repair: propensity-matched analysis in the Vascular Quality Initiative[J]. J Vasc Surg, 2020, 72(2):498-507. doi:10.1016/j.jvs.2019.11.063. [百度学术]
Seternes A, Rekstad LC, Mo S, et al. Open abdomen treated with negative pressure wound therapy: indications, management and survival[J]. World J Surg, 2017, 41(1):152-161. doi:10.1007/s00268-016-3694-8. [百度学术]
Jalalzadeh H, van Schaik TG, Duin JJ, et al. The value of sigmoidoscopy to detect colonic ischaemia after ruptured abdominal aortic aneurysm repair[J]. Eur J Vasc Endovasc Surg, 2019, 57(2):229-237. doi:10.1016/j.ejvs.2018.08.041. [百度学术]
Urbonavicius S, Feuerhake IL, Srinanthalogen R, et al. Value of routine flexible sigmoidoscopy and potential predictive factors for colonic ischemia after open ruptured abdominal aortic aneurysm repair[J]. Medicina, 2020, 56(5):229. doi:10.3390/medicina56050229. [百度学术]
Lindström I, Protto S, Khan N, et al. Statin use, development of sarcopenia, and long-term survival after endovascular aortic repair[J]. J Vasc Surg, 2021, 74(5):1651-1658. doi:10.1016/j.jvs.2021.04.054. [百度学术]
Risum Ø, Sandven I, Sundhagen JO, et al. Editor's choice - effect of statins on total mortality in abdominal aortic aneurysm repair: a systematic review and meta-analysis[J]. Eur J Vasc Endovasc Surg, 2021, 61(1):114-120. doi:10.1016/j.ejvs.2020.08.007. [百度学术]
Xiong X, Wu Z, Qin X, et al. Meta-analysis suggests statins reduce mortality after abdominal aortic aneurysm repair[J]. J Vasc Surg, 2022, 75(1):356-362. doi:10.1016/j.jvs.2021.06.033. [百度学术]
Alonso W, Ozdemir B, Chassin-Trubert L, et al. Early outcomes of native and graft-related abdominal aortic infection managed with orthotopic xenopericardial grafts[J]. J Vasc Surg, 2021, 73(1):222-231. doi:10.1016/j.jvs.2020.04.513. [百度学术]
Janko MR, Hubbard G, Back M, et al. In-situ bypass is associated with superior infection-free survival compared with extra-anatomic bypass for the management of secondary aortic graft infections without enteric involvement[J]. J Vasc Surg, 2022, 76(2):546-555. doi:10.1016/j.jvs.2022.03.869. [百度学术]
Khalid W, Puges M, Stenson K, et al. Referral centre experience with infected abdominal aortic endograft explantation[J]. Eur J Vasc Endovasc Surg, 2023, 65(1):149-158. doi:10.1016/j.ejvs.2022.10.003. [百度学术]
Langenskiöld M, Persson SE, Daryapeyma A, et al. Deep femoral vein reconstruction for abdominal aortic graft infections is associated with low aneurysm related mortality and a high rate of permanent discontinuation of antimicrobial treatment[J]. Eur J Vasc Endovasc Surg, 2021, 62(6):927-934. doi:10.1016/j.ejvs.2021.09.004. [百度学术]
Chakfé N, Diener H, Lejay A, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections[J]. Eur J Vasc Endovasc Surg, 2020, 59(3):339-384. doi:10.1016/j.ejvs.2019.10.016. [百度学术]
Geraedts ACM, Mulay S, van Dieren S, et al. Analysis of outcomes after endovascular abdominal aortic aneurysm repair in patients with abnormal findings on the first postoperative computed tomography angiography[J]. J Endovasc Ther, 2021, 28(6):878-887. doi:10.1177/15266028211030539. [百度学术]
Doumenc B, Mesnard T, Patterson BO, et al. Management of type IA endoleak after EVAR by explantation or custom made fenestrated endovascular aortic aneurysm repair[J]. Eur J Vasc Endovasc Surg, 2021, 61(4):571-578. doi:10.1016/j.ejvs.2020.10.033. [百度学术]
Juszczak M, Vezzosi M, Nasr H, et al. Fenestrated-branch endovascular repair after prior abdominal aortic aneurysm repair[J]. Eur J Vasc Endovasc Surg, 2021, 62(5):728-737. doi:10.1016/j.ejvs.2021.07.003. [百度学术]
Juszczak MT, Vezzosi M, Khan M, et al. Endovascular repair of acute juxtarenal and thoracoabdominal aortic aneurysms with surgeon-modified fenestrated endografts[J]. J Vasc Surg, 2020, 72(2):435-444. doi:10.1016/j.jvs.2019.10.056. [百度学术]
Arnaoutakis DJ, Sharma G, Blackwood S, et al. Strategies and outcomes for aortic endograft explantation[J]. J Vasc Surg, 2019, 69(1):80-85. doi:10.1016/j.jvs.2018.03.426. [百度学术]
Patel SR, Ormesher DC, Smith SR, et al. A risk-adjusted and anatomically stratified cohort comparison study of open surgery, endovascular techniques and medical management for juxtarenal aortic aneurysms-the UK COMPlex AneurySm Study (UK-COMPASS): a study protocol[J]. BMJ Open, 2021, 11(11):e054493. doi:10.1136/bmjopen-2021-054493. [百度学术]
Oderich GS, Farber MA, Schneider D, et al. Final 5-year results of the United States Zenith Fenestrated prospective multicenter study for juxtarenal abdominal aortic aneurysms[J]. J Vasc Surg, 2021, 73(4):1128-1138. doi:10.1016/j.jvs.2020.08.128. [百度学术]
Sveinsson M, Sonesson B, Kristmundsson T, et al. Long-term outcomes after fenestrated endovascular aortic repair for juxtarenal aortic aneurysms[J]. J Vasc Surg, 2022, 75(4):1164-1170. doi:10.1016/j.jvs.2021.11.050. [百度学术]
Zettervall SL, Tenorio ER, Schanzer A, et al. Secondary interventions after fenestrated/branched aneurysm repairs are common and nondetrimental to long-term survival[J]. J Vasc Surg, 2022, 75(5):1530-1538. doi:10.1016/j.jvs.2021.11.074. [百度学术]
Charisis N, Bouris V, Rakic A, et al. A systematic review on endovascular repair of isolated common iliac artery aneurysms and suggestions regarding diameter thresholds for intervention[J]. J Vasc Surg, 2021, 74(5):1752-1762. doi:10.1016/j.jvs.2021.01.064. [百度学术]
Steenberge SP, Caputo FJ, Rowse JW, et al. Natural history and growth rates of isolated common iliac artery aneurysms[J]. J Vasc Surg, 2022, 76(2):461-465. doi:10.1016/j.jvs.2022.01.022. [百度学术]
Bhalla S, Menias CO, Heiken JP. CT of acute abdominal aortic disorders[J]. Radiol Clin North Am, 2003, 41(6):1153-1169. doi:10.1016/s0033-8389(03)00136-2. [百度学术]
Eid MA, Barry MJ, Tang GL, et al. Effect of a decision aid on agreement between patient preferences and repair type for abdominal aortic aneurysm: a randomized clinical trial[J]. JAMA Surg, 2022, 157(9):e222935. doi:10.1001/jamasurg.2022.2935. [百度学术]
Machin M, Van Herzeele I, Ubbink D, et al. Shared decision making and the management of intact abdominal aortic aneurysm: a scoping review of the literature[J]. Eur J Vasc Endovasc Surg, 2023, 65(6):839-849. doi:10.1016/j.ejvs.2023.01.036. [百度学术]
Stubenrouch FE, Peters LJ, de Mik SML, et al. Improving shared decision making in vascular surgery: a stepped wedge cluster randomised trial[J]. Eur J Vasc Endovasc Surg, 2022, 64(1):73-81. doi:10.1016/j.ejvs.2022.04.016. [百度学术]
Lareyre F, Wanhainen A, Raffort J. Artificial intelligence-powered technologies for the management of vascular diseases: building guidelines and moving forward evidence generation[J]. J Endovasc Ther, 2023:15266028231187599. doi:10.1177/15266028231187599. [百度学术]