Division of Vascular Surgery, Department of Surgery, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Eur J Vasc Endovasc Surg. 2012 Apr;43(4):415-8. doi: 10.1016/j.ejvs.2012.01.013. Epub 2012 Feb 1.
The effectiveness of open and endovascular aneurysm repair of aortic abdominal aneurysms (AAAs) can be jeopardised by deterioration of the residual infrarenal neck of the aneurysm.
The study aims to determine the length of the residual infrarenal aortic segment after endovascular and open aneurysm repair.
In a multicentre randomised controlled trial comparing open and endovascular AAA repair, 165 patients were discharged after open AAA repair (OR) and 169 after endovascular repair (EVAR). Immediately after the operation, surgeons were asked to enter in the case record form whether the level of their anastomosis after open repair was within or beyond 10 mm of the caudal renal artery. Postoperative computed tomography (CT) scans that were obtained within 6 months after surgery were used for comparative analysis. The distance between the caudal renal artery and the proximal anastomosis of the (endo-) graft was measured using axial CT slices and a standardised protocol. CT images were available and suitable for analysis in 156 (95%) of 165 OR patients and in 160 (95%) of 169 EVAR patients. Data are presented as median (range). Differences were analysed using the Mann-Whitney test.
The distance from the caudal renal artery to the proximal anastomosis was 24 mm (16-30 mm) in the OR group versus 0 mm (0-6 mm) in the EVAR group (p < 0.0001, Mann-Whitney). In 140 of 156 (90%) patients, at least 1 cm of untreated infrarenal neck persisted after OR and in 17 of 160 (10%) after EVAR. In 84 of the 156 open repair patients (54%), the surgeon had indicated that the proximal anastomosis was within 10 mm of the caudal renal artery. Only five surgeons (6%) were accurate in this respect.
After open repair, a longer segment of the infrarenal aortic neck is left untreated compared with endovascular repair and this length is underestimated by most surgeons. Long-term studies are required to determine the consequences of this difference.
开放性和血管内腹主动脉瘤（AAA）修复术的有效性可能会因瘤体残余肾下颈的恶化而受到影响。
本研究旨在确定血管内和开放性 AAA 修复术后残余肾下主动脉段的长度。
在一项比较开放性和血管内 AAA 修复术的多中心随机对照试验中，165 例患者接受开放性 AAA 修复术（OR），169 例接受血管内修复术（EVAR）。在手术后，外科医生被要求在病历表中记录他们的开放性修复吻合口水平是否在肾下动脉下方 10mm 以内或以外。术后 6 个月内获得的计算机断层扫描（CT）扫描用于比较分析。使用轴向 CT 切片和标准化方案测量肾下动脉与（内）移植物近端吻合口之间的距离。在 165 例 OR 患者中有 156 例（95%）和在 169 例 EVAR 患者中有 160 例（95%）获得了 CT 图像，并适合进行分析。数据以中位数（范围）表示。使用 Mann-Whitney 检验分析差异。
OR 组肾下动脉到近端吻合口的距离为 24mm（16-30mm），而 EVAR 组为 0mm（0-6mm）（p<0.0001，Mann-Whitney）。在 156 例 OR 患者中，有 140 例（90%）至少有 1cm 未经处理的肾下颈段残留，而在 160 例 EVAR 患者中，有 17 例（10%）。在 156 例开放性修复患者中，有 84 例（54%）外科医生表示近端吻合口在肾下动脉下方 10mm 以内，只有 5 名（6%）外科医生的判断是准确的。
与血管内修复相比，开放性修复术后留下的肾下主动脉段更长，而大多数外科医生对此长度的估计不足。需要进行长期研究来确定这种差异的后果。
