University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK.
Department of Cardiovascular Sciences and the NIHR Leicester Cardiovascular Biomedical Research Unit, RKCSB, University of Leicester, Leicester, UK.
Eur J Vasc Endovasc Surg. 2014 Jan;47(1):13-8. doi: 10.1016/j.ejvs.2013.09.014. Epub 2013 Sep 19.
The lower procedural risk associated with endovascular aneurysm repair (EVAR) compared with open aneurysm repair (OAR) is well known. Younger patients are likely to represent a group at low perioperative risk. The long-term durability and late complications following EVAR may have more significance when considering the optimal treatment for young patients with a longer life expectancy. This study examined perioperative and long-term outcomes of young patients undergoing aneurysm repair by either open surgical or endovascular means.
A retrospective review of a prospectively collated database was performed. Patients undergoing elective aneurysm repair at the age of 65 years or younger between January 2000 and September 2010 were included. All EVAR patients were followed up in a nurse-led clinic. Data regarding long-term outcomes for patients undergoing open repair were gathered from case note review.
There were 99 patients who underwent open repair and 59 patients who underwent endovascular repair. Groups were well matched in terms of demographics and co-morbidities. 30-day mortality was 1% after open repair. There were no perioperative deaths after endovascular repair. Overall, 30-day complication rates were 15% after open repair and 12% after EVAR. The nature of complications differed between the two groups with the EVAR group experiencing endoleaks and the OAR group demonstrating more cardiorespiratory complications. Mean follow-up was 75.5 months and there was a 14% reintervention rate after EVAR compared with 7% after OAR.
Young patients are likely to have a lower procedural risk for EVAR and OAR than described in published figures. Although mortality and complication rates in these two groups were similar, the nature of complications occurring following open surgery were often more significant than those occurring after EVAR. There remains a risk of late reintervention following either form of repair.
与开放型动脉瘤修复术（OAR）相比，血管内动脉瘤修复术（EVAR）的手术风险较低，这一点已得到广泛认可。年轻患者可能属于低围手术期风险的人群。考虑到预期寿命较长的年轻患者的最佳治疗方法，EVAR 的长期耐久性和晚期并发症可能具有更重要的意义。本研究通过开放手术或血管内方法检查了年轻患者行动脉瘤修复术的围手术期和长期结果。
对前瞻性收集的数据库进行了回顾性分析。纳入了 2000 年 1 月至 2010 年 9 月期间年龄在 65 岁或以下行择期动脉瘤修复的患者。所有 EVAR 患者均在护士主导的诊所接受随访。通过病案回顾收集了接受开放修复的患者的长期结果数据。
有 99 例患者接受了开放修复，59 例患者接受了血管内修复。两组在人口统计学和合并症方面匹配良好。开放修复术后 30 天死亡率为 1%。血管内修复术后无围手术期死亡。总的来说，开放修复术后 30 天并发症发生率为 15%，EVAR 后为 12%。两组并发症的性质不同，EVAR 组发生内漏，OAR 组发生更多心肺并发症。平均随访时间为 75.5 个月，EVAR 后再干预率为 14%，OAR 后为 7%。
与已发表的数据相比，年轻患者行 EVAR 和 OAR 的手术风险可能较低。尽管这两组患者的死亡率和并发症发生率相似，但开放手术后发生的并发症性质通常比 EVAR 后发生的并发症更为严重。两种修复方式后均存在晚期再干预的风险。
