Pane B, Spinella G, Signori A, Musio D, Perfumo M G, Lucertini G, Rousas N, Palombo D
Vascular and Endovascular Surgery Unit University Hospital IRCCS San Martino‑IST University of Genoa, Genoa, Italy -
J Cardiovasc Surg (Torino). 2014 Apr;55(2):257-63.
The aim of our study was to evaluate the earlier and long term survival as well the postoperative complications in high-risk patients who received endovascular aortic repair (EVAR) as first choice, or open repair when anatomical requirements for EVAR were not met.
Between January 2005 and January 2010, 593 patients underwent procedures for elective abdominal aortic aneurysm (AAA) repair; 172 of these were considered at high risk according to the American Society of Anesthesiology (ASA) score (ASA III and IV): 150 high-risk patients were males (mean age 72.7, range 53-93 years) and 22 females (mean age 72.9 years, range 60-90 years). The median AAA diameter was 64 (53-75) mm in the open repair group and 62 (55-70) mm in the EVAR group. 121 patients underwent open repair and 51 EVAR, respectively.
The 30-day mortality rate was 0% in the EVAR group and 2.4% (3/121) in the open repair group (P=0.26). Long-term results showed: no EVAR-related mortality, no late conversion to open repair in the EVAR group was required during follow-up. No aneurysmal expansion was observed. In the open repair group, no graft-related events were observed during follow-up. The mean follow-up for survival analysis was 1542 days. Overall 5-year survival was 71.7% (SE=4.2%). Survival during follow-up was 92.2%, 86.1%, 76.2%, 65.9% and 61.8% at 12, 24,36,48,60 months respectively in EVAR Group. Open Group present long term survival of 95%, 88.9%, 83.9%, 79.7%, 76% at 12, 24, 36, 48, 60 months respectively.
Our results in open repair surgery show a perioperative low mortality rate with high survival rate in long term. This result could be successfully achieved even in high-risk patients unsuitable for EVAR.
我们研究的目的是评估将血管内主动脉修复术（EVAR）作为首选，或在不符合EVAR解剖要求时进行开放修复的高危患者的早期和长期生存率以及术后并发症。
2005年1月至2010年1月期间，593例患者接受了择期腹主动脉瘤（AAA）修复手术；根据美国麻醉医师协会（ASA）评分（ASA III和IV），其中172例被认为是高危患者：150例高危患者为男性（平均年龄72.7岁，范围53 - 93岁），22例为女性（平均年龄72.9岁，范围60 - 90岁）。开放修复组腹主动脉瘤的中位直径为64（53 - 75）mm，EVAR组为62（55 - 70）mm。分别有121例患者接受了开放修复，51例接受了EVAR。
EVAR组30天死亡率为0%，开放修复组为2.4%（3/121）（P = 0.26）。长期结果显示：EVAR组无与EVAR相关的死亡，随访期间无需后期转为开放修复。未观察到动脉瘤扩张。在开放修复组中，随访期间未观察到与移植物相关的事件。生存分析的平均随访时间为1542天。总体5年生存率为71.7%（标准误 = 4.2%）。EVAR组在12、24、36、48、60个月时的随访生存率分别为92.2%、86.1%、76.2%、65.9%和61.8%。开放组在12、24、36、48、60个月时的长期生存率分别为95%、88.9%、83.9%、79.7%、76%。
我们开放修复手术的结果显示围手术期死亡率低，长期生存率高。即使在不适合EVAR的高危患者中也能成功取得这一结果。
