Georgiadis George S, Trellopoulos George, Antoniou George A, Georgakarakos Efstratios I, Nikolopoulos Evagelos S, Pelekas Dimitrios, Pitta Xanthi, Lazarides Miltos K
Department of Vascular Surgery, 'Demokritus' University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
ANZ J Surg. 2013 Oct;83(10):758-63. doi: 10.1111/ans.12074. Epub 2013 Jan 21.
We sought to investigate the short- and mid-term results of the endovascular repair of infrarenal abdominal penetrating aortic ulcers (aPAUs).
Patients with infrarenal aPAUs treated by endovascular means between March 2004 and June 2012 were recruited. Pre-interventional imaging included computed tomography (CT) or CT angiography. Endoprostheses were chosen and deployed according to standard elective endovascular aneurysm repair anatomical requirements. Endpoints included 30-day survival, in-hospital mortality, 1-year PAU-related mortality, 1-year all-cause mortality, freedom from death and freedom from cumulative complication and interventions. Statistically, the Kaplan-Meier method was applied.
Nineteen patients (18 men, median age 70 years (interquartile range, IQR = 59-75)) suffering aPAUs (n = 29, infrarenal = 25) were detected. The median co-morbid severity scoring was 1.0 (IQR = 0.4-1.4). The median follow-up period was 33 months (IQR = 8-51.5). Furthermore, 94.7% of patients had hypertension. Fourteen patients (73.7%) had symptoms, including four of them admitted with shock from large-contained PAU rupture. Endoluminal stent grafting was successfully delivered in all patients. In-hospital mortality was 10.5%. Two patients required secondary interventions (10.5%). The 30-day survival, 1-year PAU-related mortality and 1-year all-cause mortality were 94.7%, 89.5% and 89.5%, respectively. Freedom from death and freedom from cumulative complications and interventions was 86.4% and 86.4%, 78.9% and 78.9%, and 67.9% and 71.2% at 12, 24 and 36 months, respectively.
Urgent and elective endovascular repair of aPAUs can be achieved with high technical success. The significant co-morbid status of the treated patients is illustrated in the considerable in-hospital mortality and underlines the advantage of such treatment over open surgical repair.
我们试图研究肾下腹主动脉穿透性溃疡（aPAU）血管腔内修复的短期和中期结果。
招募2004年3月至2012年6月期间采用血管腔内方法治疗的肾下aPAU患者。介入前影像学检查包括计算机断层扫描（CT）或CT血管造影。根据标准的选择性血管腔内动脉瘤修复解剖要求选择并植入血管内支架。观察终点包括30天生存率、住院死亡率、1年aPAU相关死亡率、1年全因死亡率、无死亡生存率以及无累积并发症和干预生存率。统计学分析采用Kaplan-Meier法。
共检测到19例患有aPAU（n = 29，肾下型 = 25）的患者（18例男性，中位年龄70岁（四分位间距，IQR = 59 - 75））。共病严重程度评分中位数为1.0（IQR = 0.4 - 1.4）。中位随访期为33个月（IQR = 8 - 51.5）。此外，94.7%的患者患有高血压。14例患者（73.7%）有症状，其中4例因巨大局限性PAU破裂伴休克入院。所有患者均成功进行了腔内支架植入术。住院死亡率为10.5%。2例患者需要二次干预（10.5%）。30天生存率、1年aPAU相关死亡率和1年全因死亡率分别为94.7%、89.5%和89.5%。12个月、第24个月和第3个月时无死亡生存率以及无累积并发症和干预生存率分别为86.4%和86.4%、78.9%和78.9%、67.9%和71.2%。
aPAU的急诊和择期血管腔内修复技术成功率高。治疗患者显著的共病状态表现为较高的住院死亡率，这突出了这种治疗方法相对于开放手术修复的优势。
