Arko Frank R, Filis Konstantinos A, Hill Bradley B, Fogarty Thomas J, Zarins Christopher K
Division of Vascular Surgery, Department of Surgery, Stanford University, Stanford, Calif., USA.
Arch Surg. 2003 Jun;138(6):651-5; discussion 655-6. doi: 10.1001/archsurg.138.6.651.
Small infrarenal abdominal aortic aneurysms have a more favorable clinical and morphologic outcome compared with medium and large abdominal aortic aneurysms following endovascular aneurysm repair(EVAR).
A prospective clinical series of 206 patients undergoing elective EVAR between 1996 and 2001.
A tertiary care academic health center.
Patients were grouped according to aneurysm size: small (<50 mm), medium (50-60 mm), and large (>60 mm).
Primary EVAR and secondary procedures to secure fixation of the stent graft and surgical conversions.
Aneurysm diameter, endoleaks, and long-term morphologic changes were analyzed postoperatively with 3-dimensional reconstructions of computed tomographic angiograms.
Groups were similar in age, comorbidities, and follow-up (mean +/- SD, 32.1 +/- 11.8 months). There were 30 small aneurysms, 92 medium aneurysms, and 84 large aneurysms, with a mean size of 45.1 +/- 3.7 mm, 53.8 +/- 3.1 mm, and 66.1 +/- 6.8 mm, respectively (P<.01). There was no significant difference in proximal neck or iliac artery diameter among the 3 groups. The proximal aortic neck length (28.1 +/- 11.6 mm [small]; 23.9 +/- 11.3 mm [medium]; and 22.1 +/- 11.6 mm [large]; P<.05) was significantly shorter in large aneurysms. Furthermore, there was a significant increase (6% [small]; 15% [medium]; and 21% [large]; P<.05) in angulated necks in large aneurysms. Following treatment, aneurysm diameter remained stable in most patients (83% [small]; 82% [medium]; and 83% [large]), with a mean decrease of 2.0 +/- 6.5 mm, 2.1 +/- 6.1 mm, and 3.7 +/- 7.7 mm in each group, respectively (P =.45). There was no difference in the incidence of endoleaks, aneurysm contraction, or aneurysm expansion based on preoperative aneurysm diameter. Secondary procedures were performed in 5 (20%) of 25, 9 (5.2%) of 170, and 5 (36%) of 11 aneurysms that contracted, remained stable, or expanded, respectively, following EVAR (P<.05).
There is a 15% increase in neck angulation and a 27% decrease in neck length in large compared with small infrarenal abdominal aortic aneurysms, with no difference in outcome. Aneurysms that are stable following EVAR have a significantly lower incidence of requiring secondary procedures.
与中大型腹主动脉瘤相比，小型肾下型腹主动脉瘤在接受血管腔内修复术（EVAR）后具有更有利的临床和形态学结果。
一项前瞻性临床系列研究，纳入了1996年至2001年间接受择期EVAR的206例患者。
一家三级医疗学术健康中心。
根据动脉瘤大小分组：小型（<50 mm）、中型（50 - 60 mm）和大型（>60 mm）。
初次EVAR以及用于确保支架移植物固定的二次手术和手术转换。
术后通过计算机断层血管造影的三维重建分析动脉瘤直径、内漏和长期形态学变化。
三组患者在年龄、合并症和随访时间（平均±标准差，32.1±11.8个月）方面相似。小型动脉瘤30例，中型动脉瘤92例，大型动脉瘤84例，平均大小分别为45.1±3.7 mm、53.8±3.1 mm和66.1±6.8 mm（P<0.01）。三组患者的近端颈部或髂动脉直径无显著差异。大型动脉瘤的近端主动脉颈部长度（小型为28.1±11.6 mm；中型为23.9±11.3 mm；大型为22.1±11.6 mm；P<0.05）明显较短。此外，大型动脉瘤的成角颈部显著增加（小型为6%；中型为15%；大型为21%；P<0.05）。治疗后，大多数患者的动脉瘤直径保持稳定（小型为83%；中型为82%；大型为83%），每组平均分别减少2.0±6.5 mm、2.1±6.1 mm和3.7±7.7 mm（P = 0.45）。基于术前动脉瘤直径，内漏、动脉瘤收缩或动脉瘤扩张的发生率无差异。在EVAR后收缩、保持稳定或扩张的动脉瘤中，分别有5例（25例中的20%）、9例（170例中的5.2%）和5例（11例中的36%）进行了二次手术（P<0.05）。
与小型肾下型腹主动脉瘤相比，大型肾下型腹主动脉瘤的颈部成角增加15%，颈部长度减少27%，但结果无差异。EVAR后稳定的动脉瘤需要二次手术的发生率显著较低。
