Sobocinski Jonathan, Maurel Blandine, Delsart Pascal, d'Elia Piervito, Guillou Matthieu, Maioli Filippo, Perot Céline, Bianchini Aurélia, Azzaoui Richard, Mounier-Vehier Claire, Haulon Stéphan
Services de Chirurgie Vasculaire, Hôpital Cardiologique, Université Lille2, CHRU de Lille, France.
Ann Vasc Surg. 2011 Jul;25(5):590-7. doi: 10.1016/j.avsg.2010.08.010.
To compare the results of the endovascular aneurysm repair (EVAR) in patients considered as unfit for surgery in a "high volume" center with the EVAR-2 trial results.
In our center, between January 2006 and December 2008, 469 endovascular aorta treatments were performed in high-risk patients. All the data were prospectively collected in a database. Among 469 patients, we selected 191 patients considered as unfit for open surgery (group 1) corresponding to the EVAR trial criteria. Variables such as postoperative mortality at 30 days and 1 year, complications rates, as well as early and late redo surgery were evaluated. Long-term pharmacological treatment before surgery was listed. These results were compared with the EVAR trial (group 2). Survival during the follow-up was calculated according to the Kaplan-Meier method.
Mortality at 30 days was 1.6% and 9% in groups 1 and 2, respectively (p = 0.002). Global complication rate was 44% and 43% in groups 1 and 2, respectively (p = 0.52). Over the follow-up period, the redo surgery rate was 13% and 26% in groups 1 and 2, respectively (p = 0.0102). In our cohort, the survival rate at 2 years was 84% with a residual number of 102 patients. Before surgery, a long-term antiplatelet treatment was prescribed in 89% and 58% of the patients and statins in 74% and 39% of the patients in groups 1 and 2, respectively (p < 0.0001).
The EVAR-2 trial conclusions are in opposition to the practice of French vascular surgeons. Endovascular treatment of abdominal aortic aneurysms in high-risk patients is justified. This study confirms the importance of a multidisciplinary treatment for high-risk patients in high-volume centers.
在一个“高手术量”中心，比较被认为不适合手术的患者接受血管内动脉瘤修复术（EVAR）的结果与EVAR-2试验的结果。
2006年1月至2008年12月期间，在我们中心对高危患者进行了469例血管内主动脉治疗。所有数据均前瞻性收集于一个数据库中。在469例患者中，我们选择了191例被认为不适合开放手术的患者（第1组），符合EVAR试验标准。评估了30天和1年时的术后死亡率、并发症发生率以及早期和晚期再次手术情况。列出了术前的长期药物治疗情况。将这些结果与EVAR试验（第2组）进行比较。根据Kaplan-Meier方法计算随访期间的生存率。
第1组和第2组30天时的死亡率分别为1.6%和9%（p = 0.002）。第1组和第2组的总体并发症发生率分别为44%和43%（p = 0.52）。在随访期间，第1组和第2组的再次手术率分别为13%和26%（p = 0.0102）。在我们的队列中，2年时的生存率为84%，剩余102例患者。术前，第1组和第2组分别有89%和58%的患者接受了长期抗血小板治疗，分别有74%和39%的患者接受了他汀类药物治疗（p < 0.0001）。
EVAR-2试验的结论与法国血管外科医生的实践相反。对高危患者进行腹主动脉瘤的血管内治疗是合理的。本研究证实了在高手术量中心对高危患者进行多学科治疗的重要性。
