Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
Eur J Vasc Endovasc Surg. 2014 Aug;48(2):161-8. doi: 10.1016/j.ejvs.2014.04.011. Epub 2014 Jun 7.
The aim was to evaluate long-term outcomes and sac volume shrinkage after endovascular popliteal artery aneurysm repair (EVPAR).
This study was a retrospective review of all EVPAR cases between 1999 and 2012. Sac volume shrinkage, long-term patency, limb salvage, and survival were evaluated using Kaplan-Meier estimates. The association of anatomical and clinical characteristics with patency was evaluated using multivariate analysis.
Forty-six EVPAR were carried out in 42 patients (mean age 78 years, 86% male; mean sac volume 45.5 ± 3.5 mL). In 93% of cases (n = 43) the procedure was elective, while in 7% of cases it was for rupture (n = 2) or acute thrombosis (n = 1). Of the 43 patients who underwent elective repair, 58% were asymptomatic and 42% symptomatic (14 claudication, 3 rest pain, and 1 compression symptoms). Technical success was 98%. Mean duration of follow-up was 56 ± 21 months. Primary patency at 1, 3, and 5 years was 82% (SE 2), 79% (SE 4), and 76% (SE 4), while secondary patency was 90% (SE 5), 85% (SE 4), and 82% (SE 1) respectively; at 5 years there was 98% limb salvage and an 84% survival rate. During follow-up 11 limbs had stent graft failure: six required conversion, one underwent amputation, and four continued with mild claudication. Of those with graft failure, 63% (7/11) occurred within the first year of follow-up. The mean aneurysm sac volume shrinkage between preoperative and 5-year post-procedure measurement was significant (45.5 ± 3.5 mL vs. 23.0 ± 5.0 mL; p < .001). Segment coverage >20 cm was a negative predictor for patency (HR 2.76; 95% CI 0.23; p = .032).
EVPAR provides successful aneurysm exclusion with good long-term patency, excellent limb salvage, and survival rates. Close surveillance is nevertheless required, particularly during the first postoperative year. Patients requiring long segment coverage (>20 cm) may be at increased risk for failure.
评估血管腔内腘动脉瘤修复术（EVPAR）后长期结果和瘤囊体积缩小情况。
本研究回顾性分析了 1999 年至 2012 年间所有接受 EVPAR 的病例。采用 Kaplan-Meier 估计评估瘤囊体积缩小、长期通畅率、肢体存活率和生存情况。采用多因素分析评估解剖学和临床特征与通畅率的关系。
42 名患者（平均年龄 78 岁，86%为男性；平均瘤囊体积 45.5±3.5ml）共进行了 46 例 EVPAR。93%（n=43）的手术为择期手术，7%（n=2）为破裂或急性血栓形成（n=1）。在 43 例择期修复的患者中，58%无症状，42%有症状（14 例跛行，3 例静息痛，1 例压迫症状）。技术成功率为 98%。平均随访时间为 56±21 个月。1、3、5 年的原发通畅率分别为 82%（SE 2）、79%（SE 4）和 76%（SE 4），继发通畅率分别为 90%（SE 5）、85%（SE 4）和 82%（SE 1）；5 年时肢体存活率为 98%，生存率为 84%。随访期间，11 例支架移植物失败：6 例需要转换，1 例截肢，4 例继续轻度跛行。在移植物失败的患者中，63%（7/11）发生在随访的第一年。术前与术后 5 年瘤囊体积缩小有显著差异（45.5±3.5ml 与 23.0±5.0ml；p<.001）。节段覆盖>20cm 是通畅率的负预测因素（HR 2.76；95%CI 0.23；p=0.032）。
EVPAR 可成功排除动脉瘤，长期通畅率、肢体存活率和生存率良好。但仍需密切监测，尤其是在术后的第一年。需要长节段覆盖（>20cm）的患者可能有更高的失败风险。
