Department of Vascular Surgery, St Franziskus Hospital Münster, Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany.
J Vasc Surg. 2012 Aug;56(2):285-90. doi: 10.1016/j.jvs.2012.01.043. Epub 2012 May 2.
To present endovascular techniques in the treatment of juxtarenal aortic aneurysms (JAAAs) in relation to surgical repair; this is the "gold standard."
Between January 2008 and December 2010, 90 consecutive patients were diagnosed with primary degenerative JAAAs (≥5.0 cm) and assigned prospectively to different operative strategies on the basis of morphologic and clinical characteristics. In particular, 59 patients were treated by endovascular means such as fenestrated endovascular abdominal aortic repair (f-EVAR, n = 29) or chimney endovascular abdominal aortic repair (ch-EVAR, n = 30) endografting, and 31 patients underwent open repair (OR, n = 31).
Early procedure-related and all-cause (30-day) procedure-related mortality was 0% for the endovascular group and 6.4% (n = 2/31) for the OR group, due to systemic inflammatory response syndrome with consecutive multi-organ failure (P = .023). Persistent postoperative hemodialysis occurred only after OR (2/31; 6.4%). The overall estimated pre- and postoperative median estimated glomerular filtration rate and creatinine values were similar in the three subgroups. There was one left renal artery occlusion for each endovascular subgroup, which presented as flank pain and was treated by iliaco-renal bypass in both cases. Transfusion requirements and length of hospital stay were significantly less in the endovascular group (P = .014 and P = .004, respectively).
Endovascular treatment of JAAA is a safe alternative for the short-term management of JAAA.
介绍血管内技术在肾动脉下主动脉瘤（JAAA）治疗中的应用，与手术修复相关；这是“金标准”。
2008 年 1 月至 2010 年 12 月，90 例连续患者被诊断为原发性退行性 JAAA（≥5.0cm），并根据形态学和临床特征前瞻性地分配到不同的手术策略中。具体而言，59 例患者采用血管内方法治疗，如分体式血管内腹主动脉修复术（f-EVAR，n=29）或烟囱血管内腹主动脉修复术（ch-EVAR，n=30）支架置入，31 例患者行开放修复术（OR，n=31）。
血管内组的早期手术相关和全因（30 天）手术相关死亡率为 0%，而 OR 组为 6.4%（n=2/31），这是由于全身炎症反应综合征伴连续多器官衰竭（P=0.023）。只有 OR 组（2/31；6.4%）术后持续需要血液透析。三组亚组的术前和术后估计肾小球滤过率和肌酐中位数值相似。每个血管内亚组均发生 1 例左肾动脉闭塞，表现为腰痛，在两种情况下均通过髂肾旁路治疗。血管内组的输血需求和住院时间明显减少（P=0.014 和 P=0.004）。
血管内治疗 JAAA 是 JAAA 短期治疗的安全替代方法。
