Vascular Center, Skane University Hospital, Malmö, Sweden.
Vascular Center, Skane University Hospital, Malmö, Sweden.
J Vasc Surg. 2020 Aug;72(2):520-530.e1. doi: 10.1016/j.jvs.2019.09.061. Epub 2019 Dec 30.
To assess the long-term results of elective abdominal aortic aneurysm (AAA) repair with a single stent graft system.
Patients undergoing elective, infrarenal endovascular aneurysm repair (EVAR) with a single-stent graft system between 1998 and 2012 were analyzed retrospectively registering pre-, intra-, and postoperative data. All imaging was reviewed. Data are presented as median and interquartile range unless otherwise stated.
A total of 543 patients were included (476 males; 74 [69-79] years). Technical success was achieved in 522 (96.1%) patients. Eight (1.5%) patients died perioperatively. Median imaging follow-up was 5.0 (2.8-8.0) years. Freedom from reinterventions was 72 ± 3% at 10 years. Primary and secondary clinical success rates were 58 ± 3% and 78 ± 2% at 10 years, respectively. Freedom from late AAA-related death was 96 ± 1% and overall survival was 32 ± 2% at 10 years. Late persistent secondary clinical failure occurred in 77 (14.2%) patients. Most of the patients with late failures did not undergo reinterventions (83.1%) because they were unfit (39 patients), refused (5 patients), or had stable mild findings (20 patients). Five patients were converted to open repair (most recent, 2008). Favorable neck anatomy was more common in the second half of the study and was associated with less proximal intraoperative adjuncts. Importantly, it also conferred higher primary and secondary clinical success (P = .001 and P < .0001) and primary and assisted freedom from type I/III endoleaks (P = .002 and P < .0001); along with lower AAA-related mortality rates (P = .008).
Elective infrarenal EVAR of asymptomatic AAA with single-stent graft has sustainable long-term results, especially when the aneurysm neck anatomy is favorable. AAA-related death and conversion to open repair are very rare events, but the overall survival after 10 years is quite low. The majority of the patients with persistent failure were unfit or refused further reinterventions or had stable findings. Good patient selection and technical developments may continue to improve the results in the future.
评估使用单一支架移植物系统择期治疗腹主动脉瘤（AAA）的长期结果。
回顾性分析 1998 年至 2012 年间接受择期、肾下腔内血管内动脉瘤修复术（EVAR）并使用单一支架移植物系统的患者，登记术前、术中及术后数据。所有影像学资料均进行了回顾性分析。数据以中位数（四分位距）表示，除非另有说明。
共纳入 543 例患者（男 476 例；74 [69-79] 岁）。522 例（96.1%）患者达到技术成功。8 例（1.5%）患者围手术期死亡。中位影像学随访时间为 5.0（2.8-8.0）年。10 年时无再干预的生存率为 72±3%。10 年时的主要和次要临床成功率分别为 58±3%和 78±2%。10 年时晚期 AAA 相关死亡率为 96±1%，总生存率为 32±2%。77 例（14.2%）患者发生晚期持续性次要临床失败。大多数晚期失败的患者未接受再次干预（83.1%），因为他们不适合（39 例）、拒绝（5 例）或有稳定的轻度发现（20 例）。5 例患者转为开放修复（最近一次为 2008 年）。研究的后半段，更常见的是有利的瘤颈解剖，术中近端辅助器械使用较少。重要的是，它还带来了更高的主要和次要临床成功率（P=0.001 和 P<0.0001）以及原发性和辅助性 1 型/3 型内漏的无发生率（P=0.002 和 P<0.0001）；同时，AAA 相关死亡率也较低（P=0.008）。
无症状 AAA 择期肾下腔 EVAR 采用单一支架移植物具有可持续的长期结果，尤其是当瘤颈解剖有利时。AAA 相关死亡和转为开放修复是非常罕见的事件，但 10 年后的总生存率相当低。大多数持续性失败的患者不适合或拒绝进一步的再干预，或有稳定的发现。良好的患者选择和技术发展可能会在未来继续改善结果。
