Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Endovasc Ther. 2010 Oct;17(5):575-84. doi: 10.1583/10-3140.1.
To compare the long-term outcomes of endovascular aneurysm repair (EVAR) using the Talent endograft for abdominal aortic aneurysms (AAAs) with large and small aortic necks.
Data on 156 patients (142 men; mean age 74.1 years, range 41-89) with adequate preoperative imaging were obtained from the prospective, nonrandomized, multicenter Talent eLPS trial, which enrolled patients from February 2002 to April 2003. Subgroup analyses were performed for AAAs with a large aortic neck diameter (≥28 mm; n=53, group 1) and those with smaller necks (<28 mm; n=103, group 2). Safety and effectiveness endpoints were evaluated at 30 days, 1 year, and 5 years post procedure.
Patients in both groups had similar gender and risk factor profiles. However, group 1 was significantly older (mean age 76.5 versus 72.9 years; p<0.01). Aside from neck diameter, the 2 groups had similar mean neck length and angulation. Group 1 also had a larger maximum aneurysm diameter (mean 58.2 versus 53.4 mm; p<0.01). At 1 year, the 2 groups had similar effectiveness endpoint results. There was a significantly lower freedom from major adverse events (MAEs) for group 1 at 30 days (79.2% versus 95.1%; p<0.01). While this trend continued to 1 year, the difference lost statistical significance (72.0% versus 85.1%; p=0.08). Freedom from all-cause mortality at 30 days (94.4% versus 100%; p<0.04) and aneurysm-related death at 1 year (93.3 versus 100%; p<0.04) also was significantly lower for group 1. At 5 years, there were no significant differences in the rates of endoleaks or aneurysm changes. The 5-year rates for freedom from aneurysm-related mortality for groups 1 and 2 were 91.2% and 98.7% (p=NS), respectively. There were 5 instances of migration in this study, all occurring in group 1 patients.
AAAs with aortic necks ≥28 mm can be treated with endovascular devices with acceptable results at 5 years. However, these patients have a higher rate of MAEs within the first year and higher migration rates at 5 years. In addition, they have a lower freedom from all-cause mortality at 30 days and aneurysm-related death at 1 year. Careful patient selection, accurate device deployment, and continued follow-up are necessary to optimize long-term results in this patient population.
比较使用 Talent 覆膜支架治疗主动脉瘤（AAA）大、小主动脉颈的长期结果。
从 2002 年 2 月至 2003 年 4 月，前瞻性、非随机、多中心 Talent eLPS 试验纳入了足够术前影像学资料的 156 例患者（142 例男性；平均年龄 74.1 岁，范围 41-89 岁）的数据。对大主动脉颈直径（≥28mm；n=53，第 1 组）和小颈直径（<28mm；n=103，第 2 组）的 AAA 进行了亚组分析。在术后 30 天、1 年和 5 年时评估安全性和有效性终点。
两组患者的性别和危险因素谱相似。然而，第 1 组患者年龄明显较大（平均年龄 76.5 岁 vs 72.9 岁；p<0.01）。除颈直径外，两组的颈长度和角度平均值相似。第 1 组的最大动脉瘤直径也较大（平均 58.2 毫米 vs 53.4 毫米；p<0.01）。1 年时，两组的有效性终点结果相似。第 1 组在 30 天时主要不良事件（MAE）的无事件率显著较低（79.2% vs 95.1%；p<0.01）。虽然这一趋势持续到 1 年，但差异失去了统计学意义（72.0% vs 85.1%；p=0.08）。第 1 组在 30 天时全因死亡率（94.4% vs 100%；p<0.04）和 1 年时动脉瘤相关死亡率（93.3% vs 100%；p<0.04）也显著较低。5 年时，两组的内漏率或动脉瘤变化率无显著差异。第 1 组和第 2 组的 5 年动脉瘤相关死亡率无事件率分别为 91.2%和 98.7%（p=NS）。本研究中有 5 例迁移，均发生在第 1 组患者中。
主动脉瘤颈直径≥28mm 的 AAA 可采用血管内装置治疗，5 年时效果可接受。然而，这些患者在术后 1 年内 MAE 发生率较高，5 年内迁移率较高。此外，他们在术后 30 天的全因死亡率和 1 年的动脉瘤相关死亡率较低。为了优化该患者人群的长期结果，需要对患者进行仔细选择、准确的装置放置和持续随访。
