Jim Jeffrey, Rubin Brian G, Geraghty Patrick J, Criado Frank J, Sanchez Luis A
Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA.
Ann Vasc Surg. 2011 Apr;25(3):306-14. doi: 10.1016/j.avsg.2010.09.007.
To evaluate the outcomes of endovascular aneurysm repair (EVAR) in patients with small (≤5.4 cm) and large (≥5.5 cm) abdominal aortic aneurysms (AAAs).
Data for this study were obtained from the prospective, nonrandomized, multicenter Talent enhanced Low Profile Stent trial that enrolled patients between February 2002 and April 2003. A total of 156 patients with adequate preoperative imaging were identified for this study. Subgroup analyses were performed for patients with small (≤5.4 cm) and large (≥5.5 cm) AAAs. Demographics, aneurysm morphology, and perioperative endpoints were assessed. Safety and effectiveness endpoints were evaluated at 30 days, 1 year, and 5 years postprocedure.
Patients with small AAAs (n = 85) had similar age, gender, and medical risk profile compared with those for larger AAAs (n = 71). The proximal aortic necks in small AAAs were longer (24.7 mm vs. 20.7 mm, p = 0.05), less angulated (27.2° vs. 34.2°, p = 0.01), and smaller (24.6 mm vs. 26.1 mm, p = 0.01). Patients with small AAAs spent less time in intensive care (8.1 hour vs. 26.3 hour, p = 0.03); however, other perioperative endpoints were similar. Although the group with small AAAs had a statistically significant higher rate of successful aneurysm treatment (96.8% vs. 84.9%, p = 0.04), no difference was observed in all other effectiveness endpoints at 12 months. No differences in freedom from major adverse events at 30 days and 365 days were reported. At 5 years, no differences in rates of migration, endoleaks, change in aneurysm diameter, or freedom from aneurysm-related mortality were found. Further subgroup analyses segregating patients with very small (≤5.0 cm, n = 55), small (5.1-5.4 cm, n = 30), and larger (≥5.5 cm) AAAs also showed no statistically significant differences in postoperative outcomes.
In a prospective clinical trial setting with long-term follow-up, patients with small (≤5.4 cm) AAAs had aortic neck characteristics which were more favorable for EVAR. Despite these anatomic differences, clinical outcomes were similar to patients with large AAAs. Thus, we conclude that EVAR for small AAA should not be routinely recommended for patients on the basis of the assumption of improved outcomes.
评估血管内动脉瘤修复术（EVAR）治疗小（≤5.4 cm）和大（≥5.5 cm）腹主动脉瘤（AAA）患者的疗效。
本研究数据来自2002年2月至2003年4月期间纳入患者的前瞻性、非随机、多中心Talent增强型低轮廓支架试验。本研究共纳入156例术前影像学资料充足的患者。对小（≤5.4 cm）和大（≥5.5 cm）AAA患者进行亚组分析。评估人口统计学、动脉瘤形态和围手术期终点。在术后30天、1年和5年评估安全性和有效性终点。
小AAA患者（n = 85）与大AAA患者（n = 71）在年龄、性别和医疗风险特征方面相似。小AAA患者的近端主动脉颈部更长（24.7 mm对20.7 mm，p = 0.05）、成角更小（27.2°对34.2°，p = 0.01）且更小（24.6 mm对26.1 mm，p = 0.01）。小AAA患者在重症监护室的时间更短（8.1小时对26.3小时，p = 0.03）；然而，其他围手术期终点相似。尽管小AAA组的动脉瘤成功治疗率在统计学上显著更高（96.8%对84.9%，p = 0.04），但在12个月时所有其他有效性终点均未观察到差异。在30天和365天时，主要不良事件发生率无差异。在5年时，在移位率、内漏、动脉瘤直径变化或动脉瘤相关死亡率方面未发现差异。进一步对非常小（≤5.0 cm，n = 55）、小（5.1 - 5.4 cm，n = 30）和大（≥5.5 cm）AAA患者进行亚组分析，术后结果也未显示出统计学上的显著差异。
在一项进行长期随访的前瞻性临床试验中，小（≤5.4 cm）AAA患者的主动脉颈部特征更有利于EVAR。尽管存在这些解剖学差异，但临床结果与大AAA患者相似。因此，我们得出结论，不应基于预后改善的假设而常规推荐对小AAA患者进行EVAR治疗。
