Adam Donald J, Fitridge Robert A, Raptis Spero
University Department of Vascular Surgery, Birmingham Heartlands Hospital, Research Institute Lincoln House, Bordesley Green East, Birmingham, United Kingdom.
J Vasc Surg. 2006 Apr;43(4):701-5; discussion 705-6. doi: 10.1016/j.jvs.2005.12.019.
To examine late reintervention rates for aortic graft-related events and new aortoiliac disease after open abdominal aortic aneurysm (AAA) repair in an Australian population.
Interrogation of a prospective computerized database identified 1256 consecutive patients (1058 men, 198 women; median age, 70 years; range, 40 to 97 years) who survived open repair of nonruptured (n = 957, group I) and ruptured (n = 299, group II) infrarenal AAA in a single institution between January 1, 1982 and December 31, 2003. Median (range) follow-up was 41 (1 to 261) months for group I and 30 (1 to 243) months for group II.
In group I, 33 patients (3.4%) underwent 38 late reinterventions: 20 patients (2.1%) for aortic graft-related events at a median (range) interval of 36 (1 to 94) months after the index AAA repair, with a 30-day mortality rate of 15%; and 13 patients (1.4%) for new aortoiliac disease at a median (range) interval of 33 (3 to 207) months, with 30-day mortality of 8%. In group II, 15 patients (5%) underwent 16 late reinterventions: 10 patients (3.3%) for aortic graft-related events at a median (range) interval of 5 (2 to 112) months, with a 30-day mortality of 10%; and five patients (1.7%) for new aortoiliac disease at a median (range) interval of 67 (39-105) months, with a 30-day mortality of 40%. There was no significant difference in the late reintervention rate between the groups: group I, 33 (3.4%) of 957 vs group II, 15 (5%) of 299 (P = .23). For all patients, the estimated survival at 1, 3, 5 and 10-years was 90%, 79.4%, 66.4%, and 31.6%, respectively; estimated survival free from reintervention at 1, 3, 5 and 10-years was 98.7%, 97.1%, 95.1%, and 91.9%, respectively.
These data demonstrate, for the first time, that open AAA repair has excellent long-term durability in an Australian population and the results compare favorably with previous reports from North America and Europe. These data represent an important benchmark for comparison of the results of endovascular AAA repair in this patient population.
研究澳大利亚人群中开放性腹主动脉瘤（AAA）修复术后主动脉移植物相关事件及新发主-髂动脉疾病的晚期再次干预率。
通过查询前瞻性计算机数据库，确定了1982年1月1日至2003年12月31日期间在单一机构接受非破裂性（n = 957，I组）和破裂性（n = 299，II组）肾下腹主动脉瘤开放性修复且存活的1256例连续患者（1058例男性，198例女性；年龄中位数70岁；范围40至97岁）。I组的中位（范围）随访时间为41（1至261）个月，II组为30（1至243）个月。
在I组中，33例患者（3.4%）接受了38次晚期再次干预：20例患者（2.1%）因主动脉移植物相关事件接受干预，在初次AAA修复后的中位（范围）间隔时间为36（1至94）个月，30天死亡率为15%；13例患者（1.4%）因新发主-髂动脉疾病接受干预，中位（范围）间隔时间为33（3至207）个月，30天死亡率为8%。在II组中，15例患者（5%）接受了16次晚期再次干预：10例患者（3.3%）因主动脉移植物相关事件接受干预，中位（范围）间隔时间为5（2至112）个月，30天死亡率为10%；5例患者（1.7%）因新发主-髂动脉疾病接受干预，中位（范围）间隔时间为67（39至105）个月，30天死亡率为40%。两组间晚期再次干预率无显著差异：I组957例中有33例（3.4%），II组299例中有15例（5%）（P = 0.23）。所有患者1年、3年、5年和10年的估计生存率分别为90%、79.4%、66.4%和31.6%；1年、3年、5年和10年无再次干预的估计生存率分别为98.7%、97.1%、95.1%和91.9%。
这些数据首次表明，开放性AAA修复在澳大利亚人群中具有出色的长期耐久性，结果与北美和欧洲先前的报告相比更具优势。这些数据是该患者群体中比较血管内AAA修复结果的重要基准。
