Gnus Jan, Ferenc Stanisław, Dziewiszek Małgorzata, Rusiecki Lesław, Witkiewicz Wojciech
Department of General and Vascular Surgery, Research and Development Centre, Voivodship Specialist Hospital in Wroclaw, Poland.
Faculty of Medicine, Wroclaw Medical University, Poland.
Adv Clin Exp Med. 2015 May-Jun;24(3):475-9. doi: 10.17219/acem/29184.
Endovascular abdominal aortic aneurysm repair has become an alternative to open surgical repair of abdominal aortic aneurysm since the early 1990s. The conventional method remains the gold standard in the treatment of Abdominal Aortic Aneurysm (AAA); however, a large percentage of patients do not qualify for this treatment due to the high risk of perioperational death and complications.
The objective of this work was to compare AAA surgeries performed by both classical and endovascular methods in years 2002-2011.
Medical documentation of elective AAA patients undergoing surgical treatment was retrospectively analyzed on the basis of archive- and computer database data. The analysis included the patients' demographics, internal disease burden, as well as causes of deaths and complications within 30 days after the procedure and 1 year follow-up.
Thirty-day and 1-year mortality rates in patients treated in the elective setting were 1.5% and 8.7% for endovascular method and 4.0% and 15.7% for the open method. The comparison of mortality rates in 115 high-risk patients undergoing elective OR treatment with 275 high-risk treatment patients undergoing EVAR surgery (7.8% vs. 1.5%, 8.7% vs. 15.7%, p<.01) showed that the endovascular method significantly reduced the mortality in the latter group.
Endovascular treatment is an attractive option in AAA; especially in heavily burdened patients, because it definitely reduces mortality. EVAR was found to be advantageous over OR in case of high-risk patients.
自20世纪90年代初以来，血管内腹主动脉瘤修复术已成为腹主动脉瘤开放手术修复的替代方法。传统方法仍然是腹主动脉瘤（AAA）治疗的金标准；然而，由于围手术期死亡和并发症风险高，很大一部分患者不符合这种治疗条件。
这项工作的目的是比较2002年至2011年采用经典方法和血管内方法进行的AAA手术。
基于存档和计算机数据库数据，对接受手术治疗的择期AAA患者的医疗记录进行回顾性分析。分析包括患者的人口统计学、内科疾病负担，以及术后30天内和1年随访期间的死亡原因和并发症。
择期治疗患者的30天和1年死亡率，血管内方法分别为1.5%和8.7%，开放方法分别为4.0%和15.7%。对115例接受择期开放手术治疗的高危患者与275例接受血管内腹主动脉瘤修复术（EVAR）的高危患者的死亡率进行比较（7.8%对1.5%，8.7%对15.7%，p<0.01），结果显示血管内方法显著降低了后一组的死亡率。
血管内治疗是AAA治疗中一个有吸引力的选择；特别是对于病情严重的患者，因为它确实降低了死亡率。在高危患者中，发现血管内腹主动脉瘤修复术比开放手术更具优势。
