Dias N V, Ivancev K, Malina M, Resch T, Lindblad B, Sonesson B
Endovascular Center Malmö--Entrance 41, UMAS, Department of Radiology, Malmö University Hospital, S-205 02 Malmö, Sweden.
Eur J Vasc Endovasc Surg. 2003 Aug;26(2):188-94. doi: 10.1053/ejvs.2002.1866.
to examine the effect of the adoption of endovascular aneurysm repair (EVAR) on the outcome of open repair (OR).
between May 1998 and December 2001, EVAR (Zenith) was performed in 117 patients, and OR was performed because of anatomic restrictions in 40 (group A), and because of young age in 11 patients (group B).
EVAR patients had higher ASA classifications (p < 0.0001). EVAR was associated with a 98.3% (115 patients) technical success rate, one conversion to OR and one fatal cardiac arrest. Thirty-day mortality was 2.6% (3 patients) in EVAR, 15% (6 patients) in group A and none in group B. There was no difference in late survival between the three groups. Late reinterventions, mainly endovascular, were more frequent in EVAR. At a median follow-up of 17 months one stent-graft had migrated 5 mm distally and five stents had fractured, but without clinical consequence.
EVAR provides good results even with inclusion of high-risk patients. The adoption of EVAR may adversely affect the results of OR offered to patients because of anatomic considerations. However, OR continues to be the first option for low-risk young patients.
探讨采用血管内动脉瘤修复术（EVAR）对开放修复术（OR）疗效的影响。
1998年5月至2001年12月期间，117例患者接受了EVAR（Zenith）治疗，40例因解剖学限制接受了OR治疗（A组），11例因年龄较轻接受了OR治疗（B组）。
EVAR患者的美国麻醉医师协会（ASA）分级较高（p < 0.0001）。EVAR的技术成功率为98.3%（115例患者），1例转为OR治疗，1例发生致命性心脏骤停。EVAR组的30天死亡率为2.6%（3例患者），A组为15%（6例患者），B组无死亡病例。三组的远期生存率无差异。EVAR组的远期再次干预（主要是血管内干预）更为频繁。中位随访17个月时，1枚覆膜支架向远端移位5 mm，5枚支架发生断裂，但均无临床后果。
即使纳入高危患者，EVAR也能取得良好效果。由于解剖学因素，采用EVAR可能会对为患者提供的OR结果产生不利影响。然而，OR仍然是低风险年轻患者的首选。
