Sultan Sherif, Acharya Yogesh, Hezima Mohieldin, Ramjohn Joshua, Miresse David, Chua Vi Long Keegan, Soliman Osama, Hynes Niamh
Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland.
Galway Clinic, Royal College of Surgeons in Ireland and National University of Ireland, Galway affiliated Hospital, Doughiska, Ireland.
Front Surg. 2022 Jul 15;9:946675. doi: 10.3389/fsurg.2022.946675. eCollection 2022.
Early diagnosis and treatment of under-recognized retroperitoneal fibrosis (RPF) are essential before reaching the poorly responsive fibrotic stage. Although most patients respond to medical therapy, relapses and unresponsiveness are common. However, open surgery in medically resistant patients is associated with major adverse clinical events.
This is a single-centre longitudinal study of optimal medical therapy (OMT) vs. endovascular aneurysm repair (EVAR) in patients presenting with RPF to our tertiary referral vascular centre. Out of 22,349 aortic referrals, we performed 1,555 aortic interventions over twenty years. Amongst them, 1,006 were EVAR, TEVAR and BEVAR. Seventeen patients (1.09%) had documented peri-aortic RPF.
Out of the 17 RPF patients, 11 received OMT only, while 6 underwent EVAR after the failure of OMT. 82% ( = 14) were male, and the median follow-up was 62.7 months (IQR: 28.2-106). Nine (52%) had immunoglobulin G4-related disease (4 OMT vs. 5 EVAR). EVAR patients had 100% technical success without perioperative mortality. Furthermore, all the EVAR patients were symptom-free following the intervention. Pre-operative aortic RPF index (maximum peri-aortic soft tissue diameter/maximum aortic diameter) was higher in the EVAR than in OMT. However, there was a significant decrement in the aortic RPF index following EVAR (= 0.04).
We believe that when optimal medical therapy fails in RPF, EVAR provides a promising outcome. Further studies are recommended to establish the role of endovascular repair.
在未被充分认识的腹膜后纤维化（RPF）进入反应不佳的纤维化阶段之前，早期诊断和治疗至关重要。虽然大多数患者对药物治疗有反应，但复发和无反应很常见。然而，对药物治疗耐药的患者进行开放手术会伴有严重的不良临床事件。
这是一项在我们的三级转诊血管中心对患有RPF的患者进行的最佳药物治疗（OMT）与血管内动脉瘤修复（EVAR）的单中心纵向研究。在22349例主动脉转诊病例中，我们在20年期间进行了1555例主动脉干预。其中，1006例为EVAR、TEVAR和BEVAR。17例患者（1.09%）有主动脉周围RPF的记录。
在17例RPF患者中，11例仅接受OMT，而6例在OMT失败后接受了EVAR。82%（n = 14）为男性，中位随访时间为62.7个月（四分位间距：28.2 - 106）。9例（52%）患有免疫球蛋白G4相关疾病（4例接受OMT，5例接受EVAR）。EVAR患者技术成功率为100%，无围手术期死亡。此外，所有接受EVAR的患者术后均无症状。EVAR患者术前主动脉RPF指数（最大主动脉周围软组织直径/最大主动脉直径）高于OMT患者。然而，EVAR后主动脉RPF指数有显著下降（= 0.04）。
我们认为，当RPF的最佳药物治疗失败时，EVAR可提供有希望的结果。建议进一步研究以确定血管内修复的作用。
