Abdominal aortic aneurysms with short proximal neck: comparison between standard endograft and open repair
| Autor: | A, Freyrie, M, Gargiulo, E, Gallitto, G L, Faggioli, G, Testi, F, Giovanetti, A, Stella |
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| Rok vydání: | 2012 |
| Předmět: |
Aged
80 and over Male Reoperation Chi-Square Distribution Time Factors Endovascular Procedures Kaplan-Meier Estimate Middle Aged Prosthesis Design Aortography Risk Assessment Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation Postoperative Complications Treatment Outcome Italy Risk Factors Multidetector Computed Tomography Humans Female Prospective Studies Aged Aortic Aneurysm Abdominal |
| Zdroj: | The Journal of cardiovascular surgery. 53(5) |
| ISSN: | 1827-191X |
| Popis: | Comparing the results of the treatment of abdominal aortic aneurysms (AAA) with infra-renal neck length ≤1 cm with open repair (OR) and with endovascular treatment (EVAR) with standard endograft.Patients treated from January 2005 to December 2009 for infra-renal AAA with neck length ≤1 cm, were prospectively included. The choice of treatment was made up on anatomical and clinical criteria. Cases treated with OR (G1) and EVAR (G2) were compared. Primary end-points were: peri-operative mortality/morbidity and re-interventions, renal function worsening at discharge, mortality and re-interventions during follow-up. Secondary end points were: procedure time, need and time of intensive unit care (IUC) hospitalization, need for blood transfusions and hospital days. The comparison between groups was estimated by the Long-rank test.Eighty-two patients were treated (76 males and 6 females); the mean age was 71.4 years (range 56-86) and the mean AAA diameter was 6.2 cm. Forty-four patients were enrolled in G1 and 38 in G2. The two groups were clinically homogeneous, except for: age (G1G2: P0.001), chronic obstructive pulmonary disease (COPD) (G1G2: P=0.016) and obesity (G1G2: P=0.045). The mean follow-up was 26 months (range 1-63.6). The overall operative mortality was 3.7%: all deaths (3 cases) occurred in G1 (6.8%) while no deaths occurred in G2 (P=NS). The association of peri-operative morbidity and mortality was higher in G1 (P=0.012). There were 7 peri-operative re-interventions, 4 in G1 (9%) and 3 in G2 (7.8%) (P=NS). There was no statistical difference in renal function worsening at discharge between the two groups. At 36 months overall survival was 84% and the survival of G1 and G2 was respectively 80.5% and 87.4% (P=NS). At 36 months, freedom from re-intervention was 82.6% in G1 and 88.4% in G2 (P=NS). All the secondary end points were significantly better in G2.These results show that EVAR with standard endograft is an effective and reliable option in AAA with neck length ≤1 cm in short and mid-term follow-up. Long-term follow-up results are needed. |
| Databáze: | OpenAIRE |
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