Smith Sumona, Mountcastle Sally, Burridge Andrea, Dodson Thomas F, Salam Atef A, Kasirajan Karthik, Milner Ross, Veeraswamy Ravi, Chaikof Elliot L
Division of Vascular Surgery and Endovascular Therapy, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, and Veterans Affairs Hospital, Atlanta, GA, USA.
Ann Vasc Surg. 2008 Mar;22(2):221-6. doi: 10.1016/j.avsg.2008.01.001.
We report our experience of endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) using the modular AneuRx Stent Graft System. We retrospectively reviewed the outcomes of 113 patients who underwent EVAR with the AneuRx system performed at our institution between October 1999 and August 2003. The mean age of this group was 72.5 years, with 71% (n = 80) over the age of 70 years and 95% (n = 107) males. Aneurysm diameter ranged 4.0-9.0 cm, with 33% (n = 37) >6.0 cm. The average duration of late follow-up was 32.6 +/- 24.8 months (median = 37). Successful deployment of the modular AneuRx system was noted in all patients. There were no immediate operative conversions, deaths within 24 hr of operation, or type I or III endoleaks observed at the completion of the procedure. Thirty-day mortality was 3.5% (n = 4). Acute deployment-related complications occurred in 10% (n = 13) of patients and included misdeployment, operative bleeding, arterial perforation/dissection, and access site complications. Acute systemic complications were present in nine patients, predominantly renal and cardiac complications. An endoleak noted at any time occurred in 25% of patients, with 40% of those requiring a secondary intervention. Two patients suffered late aneurysm rupture due to a type I endoleak and graft infection. Kaplan-Meier analysis revealed 5-year freedom from secondary intervention of 72.4%; freedom from aneurysm-related death of 93.9%; and probability of survival based on all-cause mortality of 60.1%. Endovascular treatment with the modular AneuRx Stent Graft System is safe and effective, producing acceptable rates of disease-free survival and mid-term clinical outcome.
我们报告了使用模块化AneuRx覆膜支架系统进行肾下腹主动脉瘤腔内修复术（EVAR）的经验。我们回顾性分析了1999年10月至2003年8月在我院接受AneuRx系统EVAR治疗的113例患者的治疗结果。该组患者的平均年龄为72.5岁，其中71%（n = 80）年龄超过70岁，95%（n = 107）为男性。动脉瘤直径为4.0 - 9.0 cm，其中33%（n = 37）大于6.0 cm。术后平均随访时间为32.6 ± 24.8个月（中位数 = 37个月）。所有患者均成功植入模块化AneuRx系统。术中无即刻中转手术、术后24小时内死亡，术后也未发现I型或III型内漏。30天死亡率为3.5%（n = 4）。10%（n = 13）的患者出现了与急性植入相关的并发症，包括植入失误、手术出血、动脉穿孔/夹层分离以及穿刺部位并发症。9例患者出现急性全身并发症，主要为肾脏和心脏并发症。25%的患者在随访过程中出现内漏，其中40%需要二次干预。2例患者因I型内漏和移植物感染导致动脉瘤晚期破裂。Kaplan-Meier分析显示，5年免于二次干预的概率为72.4%；免于动脉瘤相关死亡的概率为93.9%；基于全因死亡率的生存概率为60.1%。使用模块化AneuRx覆膜支架系统进行腔内治疗安全有效，可获得可接受的无病生存率和中期临床疗效。
