Endovascular aneurysm repair for symptomatic abdominal aortic aneurysms has comparable results to elective repair in the long term

被引:6
作者
Abdulrasak, Mohammed [1 ]
Sonesson, Bjorn J. [1 ]
Vaccarino, Roberta [1 ]
Singh, Bharti H. [1 ]
Resch, Timothy A. [1 ]
Dias, Nuno, V [1 ]
机构
[1] Skane Univ Hosp, Vasc Ctr, Ruth Lundskogs Gata 10,Plan 1, S-20502 Malmo, Sweden
关键词
Abdominal aortic aneurysm; Endovascular aneurysm repair; Stent graft; Symptomatic AAA;
D O I
10.1016/j.jvs.2020.03.027
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: Endovascular aneurysm repair (EVAR) has been extensively study regarding elective and ruptured abdominal aortic aneurysm (AAA) repair. However, much less is known about EVAR of symptomatic nonruptured AAA, especially concerning the long-term results. The aim of this study was to assess the outcomes of EVAR of symptomatic AAA compared with asymptomatic AAA at a tertiary center using a single graft. Methods: All consecutive patients treated for symptomatic and asymptomatic AAAs from 1998 to 2012 at our institution, using the Cook Zenith stent graft (Cook Europe NS, Bjaeverskov, Denmark), were included in the study. Ruptured AAAs were excluded. Patients' charts were reviewed to obtain preoperative, intraoperative, and postoperative data. All available imaging was reviewed. Life tables were constructed to assess for overall and late AAA-related survival, clinical success, and endoleak freedom. Results: There were 680 patients included (137 symptomatic AAAs). No difference in technical success rate (96.1% for asymptomatic AAAs vs 94.9% for symptomatic AAAs) was present (P=.477). Thirty-day mortality was more common in symptomatic AAAs (6.6% vs 1.5% for asymptomatic AAA5; P=.002). Freedom from reinterventions was 72% 3% for asymptomatic AAAs vs 73% 5% for symptomatic AAAs (P=.785) at 10 years postoperatively. There was no difference in primary (P=.300) or secondary (P=.099) clinical success between groups, although there was higher assisted clinical success (P=.023) for asymptomatic AAAs compared with symptomatic AAAs. Persistent late clinical failure was similar in both groups (14.2% for asymptomatic AAAs vs 15.3% for symptomatic AAA5; P=.732). Freedom from late AAA-related death was higher (P=.016) for asymptomatic AAAs compared with symptomatic AAAs, but the differences disappeared when the first 30 days were disregarded. Overall survival (P=.687) was similar in both groups. An adequate aneurysm neck preoperatively conferred a better outcome in end points including overall survival. Conclusions: Symptomatic AAAs have an almost quadrupled 30-day mortality compared with asymptomatic AAAs, but the outcome differences fade in the long term. An adequate aneurysm neck was associated with better outcomes including overall survival independent of the initial presentation of the AAA. These results suggest the need of improving the identification of sym ptomatic patients requiring preoperative medical optimization. However, this is often limited by the acute need of the procedure, and more intensive postoperative monitoring may have greater potential. Independently, a strict anatomic selection for infrarenal EVAR is of paramount importance for the long-term outcome.
引用
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页码:1927 / +
页数:12
相关论文
共 16 条
[1]   Cardiovascular risk prevention and all-cause mortality in primary care patients with an abdominal aortic aneurysm [J].
Bahia, S. S. ;
Vidal-Diez, A. ;
Seshasai, S. R. K. ;
Shpitser, I. ;
Brownrigg, J. R. ;
Patterson, B. O. ;
Ray, K. K. ;
Holt, P. J. ;
Thompson, M. M. ;
Karthikesalingam, A. .
BRITISH JOURNAL OF SURGERY, 2016, 103 (12) :1626-1633
[2]  
Bradbury AW, 1998, BRIT J SURG, V85, P645
[3]   Short-term and midterm survival of ruptured abdominal aortic aneurysms in the contemporary endovascular era [J].
Briggs, Charles S. ;
Sibille, Joshua A. ;
Yammine, Halim ;
Ballast, Jocelyn K. ;
Anderson, William ;
Nussbaum, Tzvi ;
Roush, Timothy S. ;
Arko, Frank R., III .
JOURNAL OF VASCULAR SURGERY, 2018, 68 (02) :408-+
[4]   Reporting standards for endovascular aortic aneurysm repair [J].
Chaikof, EL ;
Blankensteijn, JD ;
Harris, PL ;
White, GH ;
Zarins, CK ;
Bernhard, VM ;
Matsumura, JS ;
May, J ;
Veith, FJ ;
Fillinger, MF ;
Rutherford, RB ;
Kent, KC .
JOURNAL OF VASCULAR SURGERY, 2002, 35 (05) :1048-1060
[5]   Long-term outcomes after repair of symptomatic abdominal aortic aneurysms [J].
Chandra, Venita ;
Trang, Karen ;
Virgin-Downey, Whitt ;
Dalman, Ronald L. ;
Mell, Matthew W. .
JOURNAL OF VASCULAR SURGERY, 2018, 68 (05) :1360-1366
[6]   Medical optimisation can reduce morbidity and mortality associated with elective aortic aneurysm repair [J].
Dawson, J. ;
Vig, S. ;
Choke, E. ;
Blundell, J. ;
Horne, G. ;
Downham, C. ;
Loftus, I. ;
Thompson, M. M. .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2007, 33 (01) :100-104
[7]   Outcomes of symptomatic abdominal aortic aneurysm repair [J].
De Martino, Randall R. ;
Nolan, Brian W. ;
Goodney, Philip P. ;
Chang, Catherine K. ;
Schanzer, Andres ;
Cambria, Robert ;
Bertges, Daniel J. ;
Cronenwett, Jack L. .
JOURNAL OF VASCULAR SURGERY, 2010, 52 (01) :5-12
[8]   Decreased mortality with local versus general anesthesia in endovascular aneurysm repair for ruptured abdominal aortic aneurysm in the Vascular Quality Initiative database [J].
Faizer, Rumi ;
Weinhandl, Eric ;
El Hag, Selma ;
Le Jeune, Stacey ;
Apostolidou, Ioanna ;
Shafii, Susan M. ;
Lee, Cheong J. ;
Rosenberg, Michael S. ;
Reed, Amy ;
Fanola, Christina L. .
JOURNAL OF VASCULAR SURGERY, 2019, 70 (01) :92-+
[9]  
Ohrlander T, 2012, INT ANGIOL, V31, P368
[10]   Emergency treatment of acute symptomatic or ruptured abdominal aortic aneurysm. outcome of a prospective intent-to-treat by EVAR protocol [J].
Peppelenbosch, N ;
Yilmaz, N ;
van Marrewijk, C ;
Buth, J ;
Cuypers, P ;
Duijm, L ;
Tielbeek, A .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2003, 26 (03) :303-310