Department of Medical and Surgical Sciences, Universita` degli Studi, A.O. Spedali Civili Brescia, Brescia, Italy.
Updates Surg. 2012 Jun;64(2):125-30. doi: 10.1007/s13304-012-0137-4. Epub 2012 Mar 11.
Patients with abdominal aortic aneurysm (AAA) frequently have other abdominal pathologies of surgical interest (other diseases, OD). Out of 1,375 elective open aortic replacements for AAA, 315 cases with OD were subdivided in Group 1 (82 patients with "clean wound" OD) and Group 2 (233 patients with "clean-contaminated wound" OD). The results of the sub-groups in which OD was treated at the same time as AAA were analysed (1a, 66 cases and 2a, 86 cases) and compared with OD not treated at the same time as AAA (1b, 16 cases and 2b, 147 cases). EVAR was done in 12 patients with a infrarenal AAA and concomitant abdominal disease. In this group post-operative complications occurred in two patients (endoleaks) and no sign of endograft infection was developed. Mean follow-up was 36 months. Mortality was 0% in Group 1a, 1b, 2b and 5.8% in Group 2a. In Group 1a there were one haemoperitoneum, one ischaemic colitis and one graft infection. In Group 1b there were 4 nefrectomies for renal carcinoma and three emergency hernia repairs within 18 months from AAA operation. In Group 2a the follow-up was uneventful. In Group 2b there was no acute complication of OD and 57.2% of patients were subsequently operated for OD. In the EVAR group the 30-day and late mortality rates were 0 and 25%, respectively and all deaths were cancer-related. Contemporary correction of OD in open surgery for AAA should be performed in clean wound cases, while clean-contaminated operations can be done only in selected cases. EVAR is a valid alternative technique to open vascular surgery for the concomitant treatment of aortic aneurysms and abdominal pathologies.
患有腹主动脉瘤 (AAA) 的患者常常存在其他具有外科治疗意义的腹部病变 (其他疾病，OD)。在 1375 例择期开放主动脉置换术治疗 AAA 中，315 例伴有 OD 的患者分为 1 组（82 例“清洁伤口”OD）和 2 组（233 例“清洁-污染伤口”OD）。分析了同时治疗 AAA 和 OD 的亚组（1a，66 例和 2a，86 例）的结果，并与未同时治疗 AAA 和 OD 的亚组（1b，16 例和 2b，147 例）进行比较。12 例肾下 AAA 伴腹部疾病患者行 EVAR。该组术后 2 例发生并发症（内漏），无移植物感染迹象。平均随访 36 个月。1a 组、1b 组、2b 组和 2a 组的死亡率分别为 0%、0%、5.8%和 5.8%。1a 组有 1 例血腹、1 例缺血性结肠炎和 1 例移植物感染。1b 组有 4 例肾细胞癌行肾切除术，3 例疝修补术在 AAA 术后 18 个月内紧急进行。2a 组随访无异常。2b 组 OD 无急性并发症，57.2%的患者随后因 OD 接受手术治疗。在 EVAR 组，30 天和晚期死亡率分别为 0%和 25%，所有死亡均与癌症相关。AAA 开放手术中，OD 应在清洁伤口情况下同期治疗，而清洁-污染手术仅可选择性进行。EVAR 是一种有效的替代技术，可用于同时治疗主动脉瘤和腹部病变。
