JOURNAL OF CARDIOVASCULAR SURGERY
|
2019年
/
60卷
/
06期
关键词:
Aneurysm;
Aortic rupture;
Endovascular procedures;
Emergency treatment;
SINGLE-CENTER EXPERIENCE;
OPEN REPAIR;
MIDTERM OUTCOMES;
SYSTEM NELLIX;
EVAS SYSTEM;
STRATEGY;
D O I:
10.23736/S0021-9509.18.10397-1
中图分类号:
R5 [内科学];
学科分类号:
1002 ;
100201 ;
摘要:
BACKGROUND: To assess immediate and midterm outcomes of hemodynamically-unstable patients with ruptured abdominal aortic aneurysm (rAAA) treated with the Nellix endovascular sealing system (EVAS). METHODS: From June 2014 to June 2017, 21 hemodynamically-unstable rAAA patients with challenging anatomies were treated with EVAS. The mean AAA diameter and neck length measured 73 +/- 15 mm and 14 +/- 10 mm, respectively. All the patients presented an advance trauma life support (ATLS) hemorrhage class >= 1 confirming a compromised hemodynamic status. Primary endpoints include technical success, treatment success, primary safety and 30-day survival. Secondary endpoints include re-intervention rate and time free-from-reintervention. RESULTS: Technical success was achieved in 95% (N.=20/21); one patient was converted intraoperatively to open surgery due to ongoing hemorrhage. Seven re-interventions were performed within 30-days and one during the follow-up; treatment success rate of67% and re-intervention rate of 33%. Early endoleaks were diagnosed in 5 patients (24%). Primary safety was 52%. After a mean follow-up of 11 +/- 10 months, survival rates were 81%, 62% and 57% at 1, 6 and 12 months, respectively. Time free-from-reintervention was 15 +/- 11 months. CONCLUSIONS: Emergency-EVAS (eEVAS) appeared feasible and useful, especially in hemodynamically-unstable patients with challenging anatomies. There are some limitations in this cohort study and larger, prospective and comparative studies are required to confirm eEVAS as part of an emergency treatment protocol for rAAA.
机构:
St Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, EnglandSt Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, England
de Bruin, Jorg L.
Brownrigg, Jack R. W.
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St Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, EnglandSt Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, England
Brownrigg, Jack R. W.
Karthikesalingam, Alan
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St Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, EnglandSt Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, England
Karthikesalingam, Alan
Patterson, Benjamin O.
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St Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, EnglandSt Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, England
Patterson, Benjamin O.
Holt, Peter J. E.
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St Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, EnglandSt Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, England
Holt, Peter J. E.
Hinchliffe, Robert J.
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St Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, EnglandSt Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, England
Hinchliffe, Robert J.
Morgan, Robert A.
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St Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, EnglandSt Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, England
Morgan, Robert A.
Loftus, Ian M.
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St Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, EnglandSt Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, England
Loftus, Ian M.
Thompson, Matthew M.
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St Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, EnglandSt Georges Univ Hosp NHS Fdn Trust, St Georges Vasc Inst, London SW17 0QT, England
机构:
Second Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R ChinaSecond Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R China
Zhang, Simeng
Feng, Jiaxuan
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Second Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R ChinaSecond Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R China
Feng, Jiaxuan
Li, Haiyan
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Second Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R ChinaSecond Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R China
Li, Haiyan
Zhang, Yongxue
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Second Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R ChinaSecond Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R China
Zhang, Yongxue
Lu, Qingsheng
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Second Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R ChinaSecond Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R China
Lu, Qingsheng
Jing, Zaiping
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Second Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R ChinaSecond Mil Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R China
机构:
Mil Med Acad, Clin Vasc & Endovasc Surg, Belgrade 11000, Serbia
Univ Def, Mil Med Acad, Fac Med, Belgrade, SerbiaMil Med Acad, Clin Vasc & Endovasc Surg, Belgrade 11000, Serbia
Sarac, Momir
Marjanovic, Ivan
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Mil Med Acad, Clin Vasc & Endovasc Surg, Belgrade 11000, Serbia
Univ Def, Mil Med Acad, Fac Med, Belgrade, SerbiaMil Med Acad, Clin Vasc & Endovasc Surg, Belgrade 11000, Serbia
Marjanovic, Ivan
Tomic, Aleksandar
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Mil Med Acad, Clin Vasc & Endovasc Surg, Belgrade 11000, Serbia
Univ Def, Mil Med Acad, Fac Med, Belgrade, SerbiaMil Med Acad, Clin Vasc & Endovasc Surg, Belgrade 11000, Serbia
Tomic, Aleksandar
Sarac, Sanja
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机构:
Mil Med Acad, Clin Pulmol, Belgrade 11000, Serbia
Univ Def, Mil Med Acad, Fac Med, Belgrade, SerbiaMil Med Acad, Clin Vasc & Endovasc Surg, Belgrade 11000, Serbia
Sarac, Sanja
Bezmarevic, Mihailo
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Mil Med Acad, Clin Gen Surg, Belgrade 11000, SerbiaMil Med Acad, Clin Vasc & Endovasc Surg, Belgrade 11000, Serbia