Efetividade e segurança das abordagens cirúrgica e endovascular dos aneurismas aórticos no Brasil
Efetividade e segurança das abordagens cirúrgica e endovascular dos aneurismas aórticos no Brasil
Data
2023
Autores
Silva, Gleice Keli Souza da
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
Introdução: Os aneurismas de aorta apresentam alta morbimortalidade, especialmente se associada à rotura e podem ser tratados por cirurgia aberta ou endovascular. É mais frequente na aorta torácica e abdominal, seguida das artérias ilíacas e depois da esplênica.
Objetivos: Estimar a mortalidade cirúrgica e a sobrevida; comparar e avaliar fatores prognósticos preditores do tempo de a sobrevida em pacientes submetidos a tratamentos para aneurisma de aorta no SUS.
Método: Estudo envolvendo 6.041 pacientes com diagnóstico de aneurisma aórtico, submetidos à correção endovascular ou aberta, no período de 64 meses. Foi calculada a mortalidade cirúrgica e realizada análise sobrevida por meio de curvas de Kaplan-Meier (comparadas com o teste log-rank) e pelo modelo de riscos proporcionais de Cox (uni e multi variados)
Resultados: Dos 6.041 pacientes, 3.911 (64,7%) foram submetidos à correção aberta e 2.130 (35.3%), à endovascular. A maioria eram homens (74,5%) e a idade mediana da população de estudo foi de 66 anos. Dentre os pacientes que foram a óbito em 30 dias, (82,9%) haviam passado por cirurgia aberta e 219 (17,1%) por endoprótese. A análise indica que, em comparação com a categoria cirúrgica, os procedimentos do tipo percutâneos têm uma taxa de risco aproximadamente 43,57% menor para a ocorrência de óbito em 5 anos. A utilização da abordagem endovascular esteve associada de forma independente a um maior tempo de sobrevida quando comparada à cirurgia aberta. Outras variáveis estatisticamente significativas no modelo multivariado foram faixa etária, ano de internação, região acometida e rotura.
Conclusões: Houve diferença na sobrevida em curto e médio prazo dos pacientes com aneurismas de aorta tratados no Brasil pelas técnicas endovascular e cirúrgica dentro do intervalo analisado.
Introduction: Aortic aneurysms have high morbidity and mortality, especially if associated with rupture, and can be treated by open or endovascular surgery. It is more frequent in the thoracic and abdominal aorta, followed by the iliac and then the splenic arteries. Objectives: Estimate surgical mortality and survival; compare and evaluate prognostic factors that predict survival time in patients undergoing treatment for aortic aneurysm in the SUS. Method: Study involving 6,041 patients diagnosed with aortic aneurysm, who underwent endovascular or open repair over a period of 64 months. Surgical mortality was calculated and survival analysis was performed using Kaplan-Meier curves (compared with the log-rank test) and the Cox proportional hazards model (uni and multi-variable) Results: Of the 6,041 patients, 3,911 (64.7%) underwent open correction and 2,130 (35.3%) underwent endovascular repair. The majority were men (74.5%) and the median age of the study population was 66 years. Among the patients who died within 30 days, (82.9%) had undergone open surgery and 219 (17.1%) had undergone endoprosthesis. The analysis indicates that, compared to the surgical category, percutaneous procedures have an approximately 43.57% lower risk rate for death within 5 years. The use of the endovascular approach was independently associated with a longer survival time when compared to open surgery. Other statistically significant variables in the multivariate model were age group, year of hospitalization, affected region and rupture.
Introduction: Aortic aneurysms have high morbidity and mortality, especially if associated with rupture, and can be treated by open or endovascular surgery. It is more frequent in the thoracic and abdominal aorta, followed by the iliac and then the splenic arteries. Objectives: Estimate surgical mortality and survival; compare and evaluate prognostic factors that predict survival time in patients undergoing treatment for aortic aneurysm in the SUS. Method: Study involving 6,041 patients diagnosed with aortic aneurysm, who underwent endovascular or open repair over a period of 64 months. Surgical mortality was calculated and survival analysis was performed using Kaplan-Meier curves (compared with the log-rank test) and the Cox proportional hazards model (uni and multi-variable) Results: Of the 6,041 patients, 3,911 (64.7%) underwent open correction and 2,130 (35.3%) underwent endovascular repair. The majority were men (74.5%) and the median age of the study population was 66 years. Among the patients who died within 30 days, (82.9%) had undergone open surgery and 219 (17.1%) had undergone endoprosthesis. The analysis indicates that, compared to the surgical category, percutaneous procedures have an approximately 43.57% lower risk rate for death within 5 years. The use of the endovascular approach was independently associated with a longer survival time when compared to open surgery. Other statistically significant variables in the multivariate model were age group, year of hospitalization, affected region and rupture.
Description
Palavras-chave
Aneurisma aórtico, cirurgia, procedimentos endovasculares, análise de sobrevida, Aortic aneurysm, surgery, endovascular procedures, survival analysis
Citação
Silva GKS. Efetividade e seguraça das abordagens cirúrgica e endovascular dos aneurismas aórticos no Brasil. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] - Instituto Nacional de Cardiologia; 2023.