1 Departments of Vascular Surgery, Medical University of Vienna, Austria.
J Endovasc Ther. 2013 Oct;20(5):609-18. doi: 10.1583/13-4260R.1.
To test the hypothesis that endovascular treatment of delayed aneurysm rupture achieves significantly better survival rates compared to surgical conversion.
All patients sustaining delayed rupture following prior exclusion of an abdominal aortic aneurysm (AAA) either by endovascular aneurysm repair (EVAR) or open graft replacement from March 1995 through December 2011 were retrieved from a prospectively maintained database at a tertiary care university hospital. During the study period, 35 patients (32 men; mean age 72.9 years) presented with delayed rupture at a median 2.4 years (interquartile range 1.3-4.3) after initial AAA repair by EVAR (n=22) or open surgery (n=13). Causes of post-EVAR rupture were graft-related endoleaks, while ruptures after open repair occurred at anastomotic suture sites. Patients were divided into groups regarding type of treatment for delayed rupture: 20/35 (57%) underwent successful EVAR (10 redo procedures), 13/35 (37%) had surgery (3 redo procedures), and 2/35 (6%) patients received comfort care only. The primary endpoint was 30-day mortality.
The 30-day mortality after curative treatment was 25% (5/20) for endovascular treatment compared to 54% (7/13) for surgery (p=0.14). Including additional deaths beyond 30 days, the overall in-hospital mortality was 52% (17/33). The Kaplan-Meier survival estimate for patients undergoing endovascular treatment was significantly higher (p=0.011).
Endovascular treatment of delayed rupture is feasible and helps to reduce mortality. Our data suggest that endovascular procedures are a superior treatment option for EVAR-suitable patients with delayed rupture compared with surgical conversion.
检验血管内治疗迟发性动脉瘤破裂相较于手术转换能显著提高存活率的假说。
1995 年 3 月至 2011 年 12 月，从一家三级护理大学医院的前瞻性维护数据库中检索出所有在先前接受腹主动脉瘤（AAA）排除治疗后发生迟发性破裂的患者，排除方法为血管内动脉瘤修复术（EVAR）或开放移植物置换术。在研究期间，35 例患者（32 名男性；平均年龄 72.9 岁）在初始 AAA 修复后 2.4 年（四分位距 1.3-4.3）发生迟发性破裂，其中 EVAR 修复后破裂 22 例，开放手术后破裂 13 例。EVAR 后破裂的原因是移植物相关的内漏，而开放修复后的破裂发生在吻合口缝线部位。根据治疗迟发性破裂的类型将患者分为两组：20/35（57%）接受了成功的 EVAR（10 例再次手术），13/35（37%）进行了手术（3 例再次手术），2/35（6%）仅接受了舒适护理。主要终点是 30 天死亡率。
在接受根治性治疗的患者中，血管内治疗的 30 天死亡率为 25%（5/20），手术治疗为 54%（7/13）（p=0.14）。包括 30 天后的额外死亡，总住院死亡率为 52%（17/33）。接受血管内治疗的患者的 Kaplan-Meier 生存估计明显更高（p=0.011）。
血管内治疗迟发性破裂是可行的，并有助于降低死亡率。我们的数据表明，对于 EVAR 适合的迟发性破裂患者，血管内治疗较手术转换是一种更优的治疗选择。
