Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy -
Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy.
Int Angiol. 2023 Jun;42(3):216-222. doi: 10.23736/S0392-9590.23.05028-9.
The aim of this study was to report long-term results of infrarenal abdominal aortic aneurysm (AAA) in a single tertiary Hospital.
One thousand seven hundred seventy-seven consecutive AAA repairs (2003-2018) were included. Primary outcomes were all-cause mortality, AAA-related mortality, reinterventions rate. Open repair (OSR) was offered in case the patient had a functional capacity ≥4 metabolic equivalents (MET), and a predicted >10 year life expectancy. Endovascular repair (EVAR) was offered in case of hostile abdomen, presence of anatomic feasibility for standard endovascular graft, and <4 MET. Sac shrinkage was defined as a reduction of both anterior-posterior and latero-lateral diameter of the sac of at least 5 mm at the last follow-up vs. the first post- operative follow-up imaging.
Eight hundred twenty-eight (47%) OSRs and 949 (53%) EVARs were performed 90.6% (N.=1610) were male, mean age was 73.8 years. Mean follow-up was 79 (SD: 51) months. 30-day mortality was 0.7% (N.=6) and 0.6% (N.=6) for OSR and EVAR respectively (P=1). Long-term survival was better for OSR as expected by the selection criteria used (P<0.001), while AAA-related death was similar in the OSR vs. EVAR group (P=0.37); 664 (70%) sac shrinkages occurred at the last follow-up in the EVAR group. Freedom from reintervention was 97% and 96% at 1 year, 96.5% and 88.4% at 5 years, 95.8% vs. 81.7% at 10 years, and 94.6% vs.72.3% at 15 years for OSR and EVAR, respectively (P<0.001). The reintervention rate was significantly lower in the sac shrinkage vs. no-sac shrinkage subgroup and but higher than the OSR (P≤0.001). Any statistical difference was found for the survival outcome in case of sac shrinkage (P=0.1).
Open repair of an infrarenal AAA had a lower reintervention rate than EVAR even in case of a shrinked sac at a long-term follow-up. Further studies with greater sample size are needed.
本研究旨在报告单中心三级医院的肾下型腹主动脉瘤（AAA）的长期结果。
纳入了 1777 例连续的 AAA 修复术（2003-2018 年）。主要结局为全因死亡率、AAA 相关死亡率和再干预率。如果患者的功能状态≥4 代谢当量（MET），预计预期寿命>10 年，则采用开放修复术（OSR）。如果腹部情况不佳、存在标准血管内移植物的解剖可行性以及<4 MET，则采用血管内修复术（EVAR）。囊腔缩小定义为最后一次随访与术后第一次随访影像学检查相比，囊腔的前后径和左右径至少减少 5mm。
828 例（47%）行 OSR，949 例（53%）行 EVAR，90.6%（N=1610）为男性，平均年龄为 73.8 岁。平均随访时间为 79（SD：51）个月。30 天死亡率为 0.7%（N=6）和 0.6%（N=6），分别为 OSR 和 EVAR（P=1）。OSR 的长期生存率优于预期的选择标准（P<0.001），而 OSR 与 EVAR 组的 AAA 相关死亡率相似（P=0.37）；在 EVAR 组中，664 例（70%）在最后一次随访时发生了囊腔缩小。OSR 和 EVAR 组的 1 年、5 年、10 年和 15 年无再干预率分别为 97%和 96%、96.5%和 88.4%、95.8%和 81.7%、94.6%和 72.3%（P<0.001）。在囊腔缩小与无囊腔缩小亚组中，再干预率显著低于 OSR（P≤0.001），但高于 OSR。在囊腔缩小的情况下，生存结果没有发现任何统计学差异（P=0.1）。
即使在长期随访中出现囊腔缩小，肾下型 AAA 的开放修复术的再干预率也低于 EVAR。需要进一步开展更大样本量的研究。
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