May J, White G H, Yu W, Waugh R, Stephen M, Harris J P
Department of Vascular Surgery, Royal Prince Alfred Hospital, University of Sydney, NSW, Australia.
Eur J Vasc Endovasc Surg. 1997 May;13(5):472-6. doi: 10.1016/s1078-5884(97)80175-x.
Endoluminal repair of abdominal aortic aneurysms (AAA) requires the aneurysm to have a proximal neck of at least 1.5 cm between the renal arteries and the aneurysm. Therefore, there may be advantages in performing endoluminal repair in the early stages of aneurysm development. However, the results of endoluminal repair performed in patients with small aneurysms with favourable morphology are not known. The aim of this study was to determine whether a randomised trial of endoluminal repair vs. no treatment for small aneurysms would be justified by using a concurrent comparison of endoluminal repair vs. no treatment for AAA 5 cm or less in diameter in patients presenting to the same centre during a 4-year period.
Data on 117 patients presenting with AAA 5 cm or less in diameter were entered into a registry. The decision to perform endoluminal repair vs. no treatment was based on the patient's preference following surgical consultation and investigation by computed tomography. This study reports the mortality, morbidity and survival of patients presenting between June 1992 and August 1996. During this time 43 patients had endoluminal repair and 67 patients had no treatment for small AAA. Seven patients were unfit for any intervention. Despite patient selection for different management in each group, close analysis revealed that the groups were similar with regard to co-morbidities and risk factors, as well as age, sex, and size of aneurysm. Follow-up was by progress CT scanning and ranged from 1 to 51 months (mean 18 months (NT) and 22 months (ER)).
Endoluminal repair failed in six of 43 patients (14%) and resulted in 11 (25%) local vascular complications. There were two perioperative deaths and one late death in this group. Twenty-one of 67 AAA (31%) patients in the no treatment group enlarged beyond 5 cm in diameter during the study period. There was one death from aneurysm rupture and one death from myocardial infarction in this group.
The patients in the endoluminal repair group have gained an asset in having their aneurysms repaired at a cost of early morbidity following operation. These results suggest that a randomised trial of endoluminal repair vs. no treatment will become justified in the subset of patients with small AAA 5 cm or less, if the incidence of complications can be reduced by further improvements in endoluminal technology.
腹主动脉瘤（AAA）的腔内修复要求动脉瘤在肾动脉与动脉瘤之间有至少1.5厘米的近端颈部。因此，在动脉瘤发展的早期阶段进行腔内修复可能有优势。然而，在形态良好的小动脉瘤患者中进行腔内修复的结果尚不清楚。本研究的目的是通过对在4年期间到同一中心就诊的直径5厘米或更小的AAA患者进行腔内修复与不治疗的同期比较，来确定对小动脉瘤进行腔内修复与不治疗的随机试验是否合理。
将117例直径5厘米或更小的AAA患者的数据录入登记册。进行腔内修复与不治疗的决定基于患者在接受手术咨询和计算机断层扫描检查后的偏好。本研究报告了1992年6月至1996年8月期间就诊患者的死亡率、发病率和生存率。在此期间，43例患者接受了腔内修复，67例小AAA患者未接受治疗。7例患者不适合任何干预。尽管每组患者因不同的治疗选择而入选，但仔细分析显示，两组在合并症、危险因素以及年龄、性别和动脉瘤大小方面相似。通过定期CT扫描进行随访，随访时间为1至51个月（未治疗组平均18个月，腔内修复组平均22个月）。
43例患者中有6例（14%）腔内修复失败，导致11例（25%）出现局部血管并发症。该组有2例围手术期死亡和1例晚期死亡。在未治疗组的67例AAA患者中，有21例（31%）在研究期间动脉瘤直径扩大超过5厘米。该组有1例死于动脉瘤破裂，1例死于心肌梗死。
腔内修复组的患者以术后早期发病为代价，通过修复动脉瘤获得了益处。这些结果表明，如果通过进一步改进腔内技术可以降低并发症的发生率，那么对直径5厘米或更小的小AAA患者进行腔内修复与不治疗的随机试验将是合理的。
