Abdominal aortic aneurysms with short proximal neck: comparison between standard endograft and open repair

作者：Freyrie A^*; Gargiulo M; Gallitto E; Faggioli G L; Testi G; Giovanetti F; Stella A

来源：The Journal of Cardiovascular Surgery, 2012, 53(5): 617-623.

• Aortic aneurysm, abdominal
• Stents
• Treatment outcome

Aim. Comparing the results of the treatment of abdominal aortic aneurysms (AAA) with infra-renal neck length 51 cm with open repair (OR) and with endovascular treatment (EVAR) with standard endograft. %26lt;br%26gt;Methods. Patients treated from January 2005 to December 2009 for infra-renal AAA with neck length %26lt;= 1cm, were prospectively included. The choice of treatment was made up on anatomical and clinical criteria. Cases treated with OR (61) and EVAR (62) were compared. Primary end-points were: pen-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. %26lt;br%26gt;Results. 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 61 and 38 in G2. The two groups were clinically homogeneous, except for: age (G1%26lt;G2: P%26lt;0.001), chronic obstructive pulmonary disease (COPD) (G1%26lt;G2: P=0.016) and obesity (G1%26lt;G2: 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 62 (P=NS). The association of pen-operative morbidity and mortality was higher in G1 (P=0.012). There were 7 pen-operative re-interventions, 4 in 61 (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 61 and 88.4% in 62 (P=NS). All the secondary end points were significantly better in G2. %26lt;br%26gt;Conclusion. These results show that EVAR with standard endograft is an effective and reliable option in AAA with neck length 51 cm in short and mid-term follow-up. Long-term follow-up results are needed.

• 出版日期2012-10