Late rupture of abdominal aortic aneurysm after endovascular repair

被引:23
作者
Rajendran, Saissan [1 ,2 ]
May, James [1 ,2 ]
机构
[1] Royal Prince Alfred Hosp, Dept Vasc Surg, Missenden Rd, Camperdown, NSW 2050, Australia
[2] Univ Sydney, Fac Surg, Sydney, NSW, Australia
关键词
RANDOMIZED-TRIAL; DREAM-TRIAL; EUROSTAR; EVAR; EXPERIENCE; OUTCOMES; SURGERY; DESIGN; RISK;
D O I
10.1016/j.jvs.2016.05.090
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: The purpose of this study was to compare findings at presentation and surgical outcomes in patients in whom abdominal aortic aneurysms (AAAs) ruptured after endovascular repair and in patients in whom AAAs ruptured before any treatment during a defined period at a single center. Methods: This is a retrospective analysis of consecutive patients who presented to Royal Prince Alfred Hospital with ruptured AAA from September 2003 to September 2014. Medical records of each patient were reviewed to retrieve demographics, findings at presentation, and surgical outcome. Comparison of the outcomes between those occurring after endovascular repair (group 1) and those occurring without previous endovascular treatment (group 2) was made using the data collected and combining the results obtained by a previous study that analyzed the same findings between 1992 and 2003 from the same center to provide a total 22-year experience (1992-2014) at a single quaternary referral center. Results: From May 1992 to September 2014, there were 1921 elective repairs of intact infrarenal AAAs, with 1288 endovascular and 633 open repairs. During 22 years, 40 of the 1288 patients (3.1%) who underwent endovascular repair for AAA had rupture. The proportion of patients with hypotension at presentation in group 1 (13/40) was significantly less than in group 2 (108/138; P <.01). The difference in perioperative 30-day mortality rate in group 1 (8/40 [20%]) compared with group 2 (68/138 [49%]) was significant (P <.01). Conclusions: This study confirmed that endovascular AAA repair does not prevent rupture in all patients. The data suggest that rupture, when it does occur, may not be accompanied by such major hemodynamic changes and higher mortality rate as with rupture of an untreated AAA. Strict surveillance and follow-up are required, especially in patients with relatively large initial AAA diameter or presence of endoleak and graft migration, to reduce the rate of ruptures after endovascular repair. Complete prevention will remain challenging because rupture may occur without any predisposing abnormalities. With the advent of new-generation devices, continuous larger long-term studies are required to document reduction in rupture rates after endovascular aneurysm repair.
引用
收藏
页码:52 / 57
页数:6
相关论文
共 24 条
[1]   Long-term outcomes after endovascular abdominal aortic aneurysm repair - The first decade [J].
Brewster, David C. ;
Jones, John E. ;
Chung, Thomas K. ;
Lamuraglia, Glenn M. ;
Kwolek, Christopher J. ;
Watkins, Michael T. ;
Hodgman, Thomas M. ;
Cambria, Richard P. .
ANNALS OF SURGERY, 2006, 244 (03) :426-438
[2]   Guidelines for the treatment of abdominal aortic aneurysms - Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery [J].
Brewster, DC ;
Cronenwett, JL ;
Hallett, JW ;
Johnston, KW ;
Krupski, WC ;
Matsumura, JS .
JOURNAL OF VASCULAR SURGERY, 2003, 37 (05) :1106-1117
[3]   Prior endovascular abdominal aortic aneurysm repair provides no survival benefits when the aneurysm ruptures [J].
Cho, Jae-Sung ;
Park, Taeyoung ;
Kim, Jang Yong ;
Chaer, Rabih A. ;
Rhee, Robert Y. ;
Makaroun, Michel S. .
JOURNAL OF VASCULAR SURGERY, 2010, 52 (05) :1127-1134
[4]   Treatment of ruptured abdominal aortic aneurysm after endovascular abdominal aortic repair: A comparison with patients without prior treatment [J].
Coppi, Gioacchino ;
Gennai, Stefano ;
Saitta, Giuseppe ;
Silingardi, Roberto ;
Tasselli, Sebastiano .
JOURNAL OF VASCULAR SURGERY, 2009, 49 (03) :582-588
[5]   Systematic review and meta-analysis of 12 years of endovascular abdominal aortic aneurysm repair [J].
Franks, S. C. ;
Sutton, A. J. ;
Bown, M. J. ;
Sayers, R. D. .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2007, 33 (02) :154-171
[6]   Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial [J].
Greenhalgh, RM ;
Brown, LC ;
Kwong, GPS ;
Powell, JT ;
Thompson, SG .
LANCET, 2004, 364 (9437) :843-848
[7]   Endovascular versus Open Repair of Abdominal Aortic Aneurysm [J].
Greenhalgh, Roger M. ;
Brown, Louise C. ;
Powell, Janet T. ;
Thompson, Simon G. ;
Epstein, David ;
Sculpher, Mark J. .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 362 (20) :1863-1871
[8]   Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: The EUROSTAR experience [J].
Harris, PL ;
Vallabhaneni, SR ;
Desgranges, P ;
Bacquemin, JP ;
van Marrewijk, C ;
Laheij, RJF .
JOURNAL OF VASCULAR SURGERY, 2000, 32 (04) :739-749
[9]   Aneurysm sac pressure after EVAR: The role of endoleak [J].
Hinnen, J. W. ;
Koning, O. H. J. ;
van Bockel, J. H. ;
Hamming, J. F. .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2007, 34 (04) :432-441
[10]  
Konig Gosen Gabriel, 2007, Braz. J. Cardiovasc. Surg., V22, P7