Nana Petroula, Volakakis George, Spanos Konstantinos, Kouvelos George, Bareka Metaxia, Arnaoutoglou Eleni, Giannoukas Athanasios, Matsagkas Miltiadis
Department of Vascular Surgery, Larissa University Hospital, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece.
German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, UKE Hamburg, 20246 Hamburg, Germany.
J Clin Med. 2024 Sep 6;13(17):5282. doi: 10.3390/jcm13175282.
Endovascular aortic aneurysm repair (EVAR) represents a valid treatment modality for ruptured abdominal aortic aneurysms (rAAAs). This study aimed to present rAAA outcomes treated by EVAR using the Endurant endograft. A single-center retrospective analysis of consecutive patients treated with standard EVAR (sEVAR) or parallel graft (PG)-EVAR for infra- or juxta/para-renal rAAA using the Endurant endograft (1 January 2008-31 December 2023) was undertaken. The primary outcomes were technical success, mortality, and reintervention. Follow-up outcomes, including survival and freedom from reintervention, were assessed using Kaplan-Meier estimates. Eighty-eight patients were included (87.5% sEVAR and 12.5% PG-EVAR). The mean aneurysm diameter was 73.3 ± 19.3 mm (71.4 ± 22.2 mm sEVAR and 81.7 ± 33.0 mm PG-EVAR). Among 77 patients receiving sEVAR, 26 (33.8%) received an aorto-uni-iliac device. All PG-EVAR patients were managed with bifurcated devices, one receiving a single PG, seven double PGS, and three triple PGs. Technical success was 98.8% (100.0% sEVAR and 90.9% PG-EVAR). The 30-day mortality was 47.2% (50.7% sEVAR and 27.3% PG-EVAR), with nine (10.2%) deaths recorded on the table. The mean time of follow-up was 13 ± 9 months. After excluding 30-day deaths, the estimated survival was 75.5% (standard error (SE) 6.9%) at 24 months. The estimated freedom from reintervention was 89.7% (SE 5.7%) at 24 months. Only one endoleak type Ia event was recorded during follow-up. Endurant showed high technical success rates and low rates of endoleak type Ia events and reinterventions, despite the emergent setting of repair. rAAA is still a highly fatal condition within 30 days, with an acceptable mid-term survival of 30-day survivors at 75.5%.
血管腔内主动脉瘤修复术（EVAR）是治疗破裂性腹主动脉瘤（rAAA）的一种有效治疗方式。本研究旨在呈现使用Endurant血管内移植物通过EVAR治疗rAAA的结果。对2008年1月1日至2023年12月31日期间使用Endurant血管内移植物接受标准EVAR（sEVAR）或平行移植物（PG）-EVAR治疗肾下或近肾/肾旁rAAA的连续患者进行了单中心回顾性分析。主要结局指标为技术成功率、死亡率和再次干预情况。使用Kaplan-Meier估计法评估随访结局，包括生存率和无再次干预生存率。纳入88例患者（87.5%为sEVAR，12.5%为PG-EVAR）。平均动脉瘤直径为73.3±19.3mm（sEVAR为71.4±22.2mm，PG-EVAR为81.7±33.0mm）。在77例接受sEVAR的患者中，26例（33.8%）使用了主动脉单髂动脉装置。所有PG-EVAR患者均使用分叉装置进行治疗，1例使用单个PG，7例使用双PG，3例使用三PG。技术成功率为98.8%（sEVAR为100.0%，PG-EVAR为90.9%）。30天死亡率为47.2%（sEVAR为50.7%，PG-EVAR为27.3%），手术台上记录有9例（10.2%）死亡。平均随访时间为13±9个月。排除30天内死亡病例后，24个月时的估计生存率为75.5%（标准误（SE）为6.9%）。24个月时的估计无再次干预生存率为89.7%（SE为5.7%）。随访期间仅记录到1例Ia型内漏事件。尽管是在急诊修复的情况下，Endurant仍显示出较高的技术成功率、较低的Ia型内漏事件发生率和再次干预率。rAAA在30天内仍然是一种高致死性疾病，30天幸存者的中期生存率为75.5%，可接受。
