Porcellini Massimo, Nastro Piero, Bracale Umberto, Brearley Stephen, Giordano Pasquale
Department of General and Vascular Surgery, Federico II University, via Pansini 5, 80131 Naples, Italy.
J Vasc Surg. 2007 Jul;46(1):16-23. doi: 10.1016/j.jvs.2006.09.070.
The management of patients with abdominal aortic aneurysm (AAA) and concurrent malignancy is controversial. This study retrospectively assessed the outcome of endovascular repair (EVAR) and open repair (OR) for the treatment of AAA in patients undergoing curative treatment for concomitant malignancies.
All patients who underwent surgery for a nonruptured infrarenal AAA of > or =5.5 cm and concomitant malignancy between 1997 and 2005 were retrospectively reviewed.
Identified were 25 patients (22 men; mean age, 70.3 years) with nonruptured infrarenal AAA of > or =5.5 cm (mean size, 6.4 cm) and concomitant malignancy amenable for curative treatment. EVAR was used to treat 11 patients, and 14 underwent OR. The EVAR patients had a smaller mean aneurysm size (5.9 cm vs 6.8 cm; P = .006) than the OR patients. The mean cumulative length of stay for all patients who received treatment for both AAA and cancer was 12.8 days (range, 4 to 26) for EVAR and 18.2 days (range, 9 to 42 days) for OR. In the EVAR group, no patients died perioperatively; in the OR group, three patients died perioperatively (21.4%; P = NS). Postoperative complications occurred in one patient in the EVAR group and in seven in the OR group for a morbidity rate, respectively, of 9.1% and 50% (P = .04). One late complication (9.1%) occurred in the EVAR group. The mean follow-up was 37.7 months (range, 16 to 60 months) in the EVAR group and 29.6 months (range, 11 to 55 months) in the OR group. At 1 and 2 years, survival rates were 100% and 90.9% in the EVAR group and 71.4% and 49% in the OR group (log-rank P = .103)
With low morbidity and mortality, EVAR is a safe technique for the treatment of AAA in patients with concomitant malignancy and could be considered as an alternative to OR.
腹主动脉瘤（AAA）合并恶性肿瘤患者的治疗存在争议。本研究回顾性评估了接受根治性治疗的合并恶性肿瘤患者行血管腔内修复术（EVAR）和开放修复术（OR）治疗AAA的疗效。
回顾性分析1997年至2005年间所有接受手术治疗的肾下腹主动脉瘤直径≥5.5 cm且合并恶性肿瘤的患者。
共确定25例患者（22例男性；平均年龄70.3岁），肾下腹主动脉瘤直径≥5.5 cm（平均大小6.4 cm）且合并适合根治性治疗的恶性肿瘤。11例患者采用EVAR治疗，14例行OR。EVAR组患者的平均动脉瘤大小（5.9 cm对6.8 cm；P = 0.006）小于OR组。所有同时接受AAA和癌症治疗的患者中，EVAR组的平均累计住院时间为12.8天（范围4至26天），OR组为18.2天（范围9至42天）。EVAR组无患者围手术期死亡；OR组有3例患者围手术期死亡（21.4%；P = 无统计学意义）。EVAR组1例患者发生术后并发症，OR组7例，发病率分别为9.1%和50%（P = 可编辑文档 0.04）。EVAR组发生1例晚期并发症（9.1%）。EVAR组的平均随访时间为37.7个月（范围16至60个月），OR组为29.6个月（范围11至55个月）。1年和2年时，EVAR组的生存率分别为100%和90.9%，OR组为71.4%和49%（对数秩检验P = 0.103）
EVAR治疗合并恶性肿瘤的AAA患者时具有较低的发病率和死亡率，是一种安全的技术，可被视为OR的替代方法。
