Division of Vascular Surgery, Mayo Clinic, Phoenix, AZ 85054, USA.
J Vasc Surg. 2012 Oct;56(4):951-5; discussion 955-6. doi: 10.1016/j.jvs.2012.03.253. Epub 2012 Jun 15.
Inflammatory abdominal aortic aneurysms (IAAAs) have been traditionally managed with open repair. Endovascular aneurysm repair (EVAR) was approved September of 1999. Some authors have suggested that EVAR is not an acceptable option for management of an IAAA. However, several recent reports have suggested EVAR is a reasonable management option in these patients. The purpose of our study was to review our experience with the contemporary management of IAAA involving both open and endovascular approaches.
A retrospective review of all patients undergoing repair of IAAAs from 1999 to 2011 was conducted at three geographically separate institutions. Basic demographics, diagnostic workup, treatment, and outcomes were reviewed.
Between 1999 and 2011, 69 patients underwent surgical repair of IAAAs, 59 by open repair and 10 by EVAR. Eighty-three percent of patients were men with a mean age of 67. Aneurysm size was similar in both groups (6.3 cm open repair vs 5.9 cm EVAR). Follow-up for the open group was a mean of 42.6 months and 33.6 months for the EVAR group. Periaortic fibrosis decreased from a mean of 5.4 mm to 2.7 mm after EVAR. Hydronephrosis was present preoperatively in one patient and did not change after EVAR. Aneurysm size decreased in seven patients (70%) who underwent EVAR. Two patients had no change with one lost to follow-up. Mean aneurysm size decrease after EVAR was 1.12 cm (17.8%). There were no aneurysm-related deaths or major morbidities in the EVAR group. Twenty-two patients (37%) in the open surgical group suffered major complications, including myocardial infarction, renal failure, lower extremity amputation, sepsis, and prolonged ventilation.
Endovascular repair for IAAA results in successful management with improvement of periaortic inflammation. EVAR should be considered as first-line therapy in which anatomic parameters are favorable.
炎症性腹主动脉瘤（IAAA）传统上采用开放修复治疗。血管内动脉瘤修复术（EVAR）于 1999 年 9 月获得批准。一些作者认为 EVAR 不是 IAAA 治疗的可接受选择。然而，最近的一些报告表明，EVAR 是这些患者的合理治疗选择。我们研究的目的是回顾我们在使用开放和血管内方法治疗 IAAA 方面的经验。
在三个地理位置不同的机构对 1999 年至 2011 年间接受 IAAA 修复的所有患者进行了回顾性审查。回顾了基本人口统计学、诊断检查、治疗和结果。
1999 年至 2011 年间，69 例患者接受了 IAAA 的手术修复，其中 59 例采用开放修复，10 例采用 EVAR。83%的患者为男性，平均年龄为 67 岁。两组患者的动脉瘤大小相似（开放修复为 6.3cm，EVAR 为 5.9cm）。开放组的平均随访时间为 42.6 个月，EVAR 组为 33.6 个月。EVAR 后，腹主动脉周围纤维化从平均 5.4mm 减少到 2.7mm。1 例患者术前存在肾盂积水，EVAR 后无变化。7 例（70%）接受 EVAR 的患者的动脉瘤大小减小。2 例无变化，1 例失访。EVAR 后平均动脉瘤直径减小 1.12cm（17.8%）。EVAR 组无动脉瘤相关死亡或重大并发症。开放手术组 22 例（37%）患者发生重大并发症，包括心肌梗死、肾衰竭、下肢截肢、脓毒症和长时间通气。
EVAR 治疗 IAAA 可成功治疗，并改善腹主动脉周围炎症。如果解剖参数有利，EVAR 应被视为一线治疗方法。
