School of Health Sciences, Department of Vascular Surgery, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece -
School of Health Sciences, Department of Vascular Surgery, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
Int Angiol. 2021 Jun;40(3):240-247. doi: 10.23736/S0392-9590.21.04648-4. Epub 2021 Mar 19.
Endovascular aneurysm repair (EVAR) has become the treatment of choice for abdominal aortic aneurysm (AAA), demonstrating excellent early outcomes. However, EVAR durability has been questioned in the long-term period. The aim of this study was to assess EVAR outcomes in terms of survival and freedom from re-intervention during a long-term period.
All consecutive patients being treated, with elective standard EVAR, in a single tertiary center, were included between 2008 and 2018. Outcomes were defined as survival and freedom from re-intervention and were reported using Kaplan-Meyer lifetables. In subgroup analyses, sex, age (threshold at 65 and 80 years), neck diameter>28mm and type of fixation were also analyzed. Type of re-intervention and endoleak type I (ETIa) were also reported.
Five hundred and eight patients (94% males, mean age 72±7.3, mean AAA diameter 59±9mm) were included. The median follow-up was 3 years (range 0-10 years). The survival rate was 92.8% (SE 1.5%), 76.5% (SE 3.1%) and 41.6% (SE 6%), at 2, 5 and 10 years of follow-up, respectively. In total, 78 patients died; 8 deaths (8/75, 10%) were aneurysm related. In multivariate regression analysis, age (CI. 1.02-1.14; p=0.006) and ever tobacco use (CI. 1.02-6.12, P=0.045) were associated with the long-term mortality. Freedom from re-intervention was 96% (SE 1.1%), 93% (SE 1.8%), 85.5% (SE 5%) at 2, 5 and 9 years of follow-up. Limb occlusion was a common complication (n/n; 30% of re-intervention), particularly within the first 2 postoperative years. Six patients presented with rupture and were treated with open conversion. EVAR cases with supra-renal fixation graft presented lower rates of ETIa (CI. 76-87.27, P<0.001).
Elective standard EVAR is associated with good long-term survival showing low aneurysm-related mortality. Common risk factors such as advanced age and smoking are associated to higher mortality. The procedure presents low re-intervention rates, while limb occlusion is a complication presented within the first 2 postoperative years.
血管内动脉瘤修复术（EVAR）已成为治疗腹主动脉瘤（AAA）的首选方法，其早期结果非常出色。然而，EVAR 的长期耐久性一直受到质疑。本研究旨在评估 EVAR 在长期期间的生存和免于再次干预的结果。
2008 年至 2018 年期间，在一家三级中心对接受择期标准 EVAR 治疗的所有连续患者进行了入组。结果定义为生存和免于再次干预，并使用 Kaplan-Meier 生命表进行报告。在亚组分析中，还分析了性别、年龄（阈值为 65 岁和 80 岁）、颈部直径>28mm 和固定类型。还报告了再次干预的类型和 1 型内漏（ETIa）。
508 名患者（94%为男性，平均年龄 72±7.3 岁，平均 AAA 直径 59±9mm）被纳入研究。中位随访时间为 3 年（0-10 年）。2 年、5 年和 10 年的生存率分别为 92.8%（SE 1.5%）、76.5%（SE 3.1%）和 41.6%（SE 6%）。共有 78 例患者死亡；8 例死亡（8/75，10%）与动脉瘤相关。在多变量回归分析中，年龄（CI 1.02-1.14；p=0.006）和既往吸烟（CI 1.02-6.12，P=0.045）与长期死亡率相关。免于再次干预的比例为 96%（SE 1.1%）、93%（SE 1.8%）、85.5%（SE 5%），随访 2、5 和 9 年时。肢体闭塞是一种常见的并发症（n/n；再次干预的 30%），尤其是在术后 2 年内。6 例患者出现破裂，采用开放转换治疗。肾上固定移植物的 EVAR 病例中 ETIa 发生率较低（CI 76-87.27，P<0.001）。
择期标准 EVAR 与良好的长期生存率相关，动脉瘤相关死亡率较低。年龄较大和吸烟等常见危险因素与更高的死亡率相关。该手术的再干预率较低，而肢体闭塞是术后 2 年内出现的一种并发症。
