Choi Eol, Kwon Tae Won
Division of Vascular Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
Division of Trauma Surgery, Department of Surgery, Korea University Guro Hospital, Seoul, Korea.
Vasc Specialist Int. 2024 Sep 27;40:31. doi: 10.5758/vsi.240041.
Endovascular treatment (EVT) has been shown to be effective and safe for isolated iliac artery aneurysms (IAAs). However, concerns remain regarding the lack of consideration to recent advances in perioperative care and surgical techniques, as well as a significant number of re-interventions with EVT. This study compares the outcomes of open surgical repair (OSR) and EVT using recent clinical data.
This retrospective, single-center study included patients who underwent OSR or EVT for isolated degenerative IAAs between January 2007 and December 2018. Primary outcomes were procedure time, number of transfusions during admission, length of hospital stay, complications, and number of preserved internal iliac arteries. Secondary outcomes included all-cause and aneurysm-related mortality, and re-intervention rates.
Fifty-eight consecutive patients underwent treatment for isolated IAAs (25 underwent OSR and 33 underwent EVT), with a median follow-up of 75 months (range: 39-133 months). Baseline characteristics were similar between the groups, except for a lower mean age in the OSR group than in the EVT group (66.0±8.2 vs. 73.1±8.6, P=0.003). Both groups had a mild risk of comorbidity severity score. Early complications (within 30 days of the procedure) occurred more frequently in the OSR group, though not statistically significant (24.0% vs. 6.1%, P=0.07). Late complications, including sac expansion and thrombotic occlusion, were significantly more common in the EVT group (15.2% vs. 0%, P=0.04). Re-intervention rate was higher in the EVT group but not statistically significant (9.1% vs. 4.0%, P=0.44). No significant differences were observed in major adverse cardiovascular events and mortality between the groups (P=0.66 and P=0.27), and there were no aneurysm-related deaths.
For patients with mild risk factors, EVT does not offer a survival or re-intervention advantages over OSR in the treatment of isolated IAAs. However, EVT is associated with an increased risk of late complications. Although larger randomized studies are necessary, OSR may be considered the first-line treatment for isolated IAAs in younger and mild-risk patients.
血管内治疗（EVT）已被证明对孤立性髂动脉瘤（IAA）有效且安全。然而，对于围手术期护理和手术技术的最新进展缺乏考虑，以及EVT大量的再次干预，人们仍存在担忧。本研究使用最新临床数据比较开放手术修复（OSR）和EVT的结果。
这项回顾性单中心研究纳入了2007年1月至2018年12月期间因孤立性退行性IAA接受OSR或EVT的患者。主要结局指标为手术时间、住院期间输血次数、住院时间、并发症以及保留的髂内动脉数量。次要结局指标包括全因死亡率和动脉瘤相关死亡率以及再次干预率。
58例连续患者接受了孤立性IAA治疗（25例行OSR，33例行EVT），中位随访时间为75个月（范围：39 - 133个月）。除OSR组平均年龄低于EVT组外（66.0±8.2 vs. 73.1±8.6，P = 0.003），两组基线特征相似。两组合并症严重程度评分风险均较低。早期并发症（术后30天内）在OSR组中更频繁发生，尽管无统计学意义（24.0% vs. 6.1%，P = 0.07）。晚期并发症，包括瘤囊扩张和血栓闭塞，在EVT组中明显更常见（15.2% vs. 0%，P = 0.04）。EVT组再次干预率更高，但无统计学意义（9.1% vs. 4.0%，P = 0.44）。两组在主要不良心血管事件和死亡率方面未观察到显著差异（P = 0.66和P = 0.27），且无动脉瘤相关死亡。
对于风险因素较低的患者，在治疗孤立性IAA方面，EVT相较于OSR在生存或再次干预方面并无优势。然而，EVT与晚期并发症风险增加相关。尽管需要更大规模的随机研究，但对于年轻且风险较低的患者，OSR可被视为孤立性IAA的一线治疗方法。
