Healy Gerard M, Redmond Ciaran E, Gray Sam, Iacob Lucian, Sheehan Stephen, Dowdall Joseph F, Barry Mary, Cantwell Colin P, Brophy David P
1 Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland.
2 Department of Vascular Surgery, St. Vincent's University Hospital, Dublin, Ireland.
Vasc Endovascular Surg. 2017 Jul;51(5):274-281. doi: 10.1177/1538574417703268.
To assess rates of complications, secondary interventions, survival, and cause of death following endovascular abdominal aortic aneurysm (AAA) repair over a 10-year period.
Single-institution retrospective cohort study of all patients undergoing primary endovascular aortic aneurysm repair (EVAR) between July 2006 and June 2015. The population constituted 175 patients with 163 fusiform and 12 saccular AAAs. Of these, 149 (85%) were male, with mean age 75.4 (±7.1) years. Patients were followed up until June 30, 2016. Cause of death was determined from the national death register.
Mean follow-up was 34.4 (±24.4) months. The secondary intervention rate was 9.7%, and there were 4 aneurysm ruptures (0.8% annual incidence). Thirty-day mortality was 0.6%. Survival at 1, 3, and 5 years was 93.1%, 84%, and 64.9%, respectively. Forty-eight patients died during follow-up, 3 secondary to rupture, leading to overall and aneurysm-related death rates of 9.7 and 0.6 per 100 person-years. All other deaths were due to nonaneurysm causes, most commonly cardiovascular (n = 15), pulmonary (n = 13), and malignancy (n = 9). Baseline renal impairment ( P < .001), ischemic heart disease ( P < .05), age greater than 75 years ( P < .05), and urgent/emergency EVAR were associated with inferior long-term survival. Type II endoleak negatively influenced fusiform aneurysm sac regression ( P = .02), but there was no association between survival and occurrence of any complication or secondary intervention.
The majority of deaths during medium-term follow-up post-EVAR are due to nonaneurysm-related causes. Survival is determined by the following baseline factors: renal impairment, ischemic heart disease, advanced age, and the presence of a symptomatic/ruptured aneurysm.
评估10年间血管腔内修复腹主动脉瘤（AAA）后的并发症发生率、二次干预情况、生存率及死亡原因。
对2006年7月至2015年6月期间所有接受初次血管腔内主动脉瘤修复术（EVAR）的患者进行单中心回顾性队列研究。研究人群包括175例患者，其中163例为梭形AAA，12例为囊状AAA。其中，149例（85%）为男性，平均年龄75.4（±7.1）岁。对患者随访至2016年6月30日。死亡原因根据国家死亡登记确定。
平均随访时间为34.4（±24.4）个月。二次干预率为9.7%，有4例动脉瘤破裂（年发生率0.8%）。30天死亡率为0.6%。1年、3年和5年生存率分别为93.1%、84%和64.9%。48例患者在随访期间死亡，3例死于破裂，导致总死亡率和与动脉瘤相关的死亡率分别为每100人年9.7例和0.6例。所有其他死亡均由非动脉瘤原因引起，最常见的是心血管疾病（n = 15）、肺部疾病（n = 13）和恶性肿瘤（n = 9）。基线肾功能损害（P <.001）、缺血性心脏病（P <.05）、年龄大于75岁（P <.05）以及紧急/急诊EVAR与较差的长期生存率相关。II型内漏对梭形动脉瘤瘤腔缩小有负面影响（P =.02），但生存率与任何并发症或二次干预的发生之间无关联。
EVAR术后中期随访期间的大多数死亡是由非动脉瘤相关原因引起的。生存率由以下基线因素决定：肾功能损害、缺血性心脏病、高龄以及有症状/破裂的动脉瘤。
