背景:采用开窗和分支装置(F/BEVAR)的复杂腹部(CAAA)和胸腹主动脉瘤(TAAA)的血管内修复术代表了老年或不适合患者的一线治疗。目前,这些技术的广泛传播导致复杂的血管内手术在年轻和更健康的患者中也逐渐增加,但相关结果报道很少,没有长期数据.我们调查了F/BEVAR在年轻和健康患者中用于CAAA和TAAA修复的长期结果。
方法:所有连续患者,70岁或更小,在过去的13年中,在两个大专院校中接受了CAAA和TAAA的F/BEVAR。根据血管外科学会(SVS)临床合并症分级系统,所有受试者均呈现低到中等风险。主要终点是技术和临床成功,晚期总生存率和主动脉相关生存率。主要并发症和特定目标血管相关结果作为次要终点进行研究。
结果:总共183名患者(155名男性,84.7%;平均年龄64.5+5.7岁,范围33-70)在研究期间接受F/BEVAR,共167例(91.3%)退行性动脉瘤和16例(8.7%)夹层后动脉瘤,包括44例(24%)结侧动脉瘤,33例(18%)肾旁动脉瘤和106例(58%)胸腹主动脉瘤。176例(96.2%)和171例(93.4%)患者获得技术和临床成功,分别。4名患者(2.2%)围手术期死亡,其中2人(1.1%)在紧急情况下运作。术后,5例患者(2.7%)出现永久性3级脊髓损伤,和3(1.6%)需要永久透析的肾衰竭。平均随访时间为65.739.6个月(范围1-158)。估计12、60和120个月时的总生存率和主动脉相关生存率为94.0%,85.1%,72.2%,97.8%,97.8%,96.2%,分别,而再干预和分支无不稳定生存的同时垃圾邮件为84.4%,71.8%,71.8%,和93.2%,86.3%,72.2%,分别。在6例患者(3.3%)中检测到动脉瘤生长>5mm,而在118例(64.5%)中,囊收缩>5mm。Cox回归分析表明,非计划手术是总死亡率的唯一危险因素[OR=3.331(1.397-7.940),p<0.01]。
结论:在年轻和健康患者中,F/BEVAR导致低的围手术期死亡率和主要发病率,和良好的长期总生存率使得该技术在这样的患者亚组中特别有吸引力。从年轻患者的结果得出的长期数据的可用性,还可以提供有用的信息来重新定义治疗适应症,并允许未来的目标设备和技术改进。
BACKGROUND: Endovascular repair of complex abdominal (CAAA) and thoracoabdominal aortic aneurysms (TAAA) with fenestrated and branched devices (F/BEVAR) represents the first-line treatment in old or unfit patients. Currently, the widespread diffusion of these techniques has led to a progressive increase of complex endovascular procedures also in younger and fitter patients, but the related results have been only minimally reported without long-term data. We investigated the long-term results of F/BEVAR for CAAA and TAAA repair in young and fit patients.
METHODS: All consecutive patients, aged 70 or younger, undergone F/BEVAR for CAAA and TAAA over the last 13 years at two tertiary Institutions were included in the study. All subjects presented a low to intermediate risk according to the Society for Vascular Surgery (SVS) clinical comorbidity grading system. The primary endpoints were technical and clinical success, late overall and aortic-related survival. Major complications and specific target vessel-related outcomes were investigated as secondary endpoints.
RESULTS: A total of 183 patients (155 males, 84.7%; mean age 64.5 + 5.7 years, range 33-70) underwent F/BEVAR during the study period, for a total of 167 (91.3%) degenerative and 16 (8.7%) post-dissection aneurysms including 44 (24%) juxtarenal, 33 (18%) pararenal and 106 (58%) thoraco-abdominal aortic aneurysms. Technical and clinical success were achieved in 176 (96.2%) and 171 patients (93.4%), respectively. Four patients (2.2%) died perioperatively, of which 2 (1.1%) operated in emergency. Postoperatively, 5 patients (2.7%) presented permanent grade 3 spinal cord injury, and 3 (1.6%) renal failure needing permanent dialysis. The mean follow-up was 65.7 + 39.6 months (range 1-158). Estimated overall and aortic-related survival at 12, 60, and 120 months was 94.0%, 85.1%, 72.2%, and 97.8%, 97.8%, 96.2%, respectively, while reintervention and branch instability-free survival at the same time spam was 84.4%, 71.8%, 71.8%, and 93.2%, 86.3%, 72.2%, respectively. An aneurysm growth > 5 mm was detected in 6 patients (3.3%) while a sac shrinkage > 5 mm was achieved in 118 cases (64.5%). The Cox regression analysis demonstrated the need for unplanned procedure as the only risk factor for overall mortality [OR=3.331 (1.397-7.940), p < 0.01].
CONCLUSIONS: F/BEVAR in young and fit patients led to a low perioperative mortality and major morbidity, and favorable overall survival rate in the long-term making this technique particularly appealing in such a subgroup of patients. The availability of long-term data derived from the results of young patients, may additionally provide helpful information to re-define indication for treatment and allow future targeted device and technique improvements.