Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report
Secondary interventions following endovascular abdominal aortic aneurysm repair using current endografts. A EUROSTAR report
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DOI：
10.1016/j.jvs.2006.01.010
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发表时间：
2006-05-01
影响因子：
4.3
通讯作者：
Buth, J
中科院分区：
文献类型：
--
作者：
Hobo, R;Buth, J
目的：通过对1999年12月至2004年12月收治的2846例腹主动脉瘤患者的临床资料进行分析，探讨血管内支架置入治疗腹主动脉瘤术后二次介入治疗的必要性。这些数据是从欧洲之星的登记中记录下来的。唯一被研究的患者是那些随访至少12个月或直到他们在前12个月内进行二次干预的患者。结果：247例(8.7%)患者在首次手术后平均12个月进行了二次介入治疗，平均随访时间为23-12个月。其中57例(23%)采用经腹途径，43例(16%)采用解剖外搭桥术，147例(60%)采用经股动脉途径。1、2、3、4年二次干预累计发生率分别为6.0%、8.7%、12%、14%。这与二次干预的年率为4.6%相对应，这明显低于之前发表的欧洲之星对1999年前接受治疗的患者的研究。I型内漏(33%的手术)、移位(16%)和破裂(8.8%)是二次经腹介入治疗最常见的原因。移植物肢体血栓形成是解剖外搭桥术的指征(60%)。I型内漏(17%)、II型内漏(23%)、设备肢体狭窄(14%)、血栓形成(23%)和设备移位(14%)是二次经股动脉介入治疗最常见的原因。二次经腹介入治疗的手术死亡率(12.3%，P=0.007)高于股动脉介入治疗(2.7%)。二次经腹(P=.016)和解剖外介入(P
Objective: The purpose of this study was to evaluate the need for secondary interventions after endovascular abdominal aortic aneurysm repair with current stent-grafts.Methods: Studied were data from 2846 patients treated from December 1999 until December 2004. The data were recorded from the EUROSTAR registry. The only patients studied were those with a follow-up of at least 12 months or until they had a secondary intervention within the first 12 months. The cumulative incidences of secondary transabdominal, extra-anatontic, and transfemoral interventions during follow-up (after the first postoperative month) were investigated.Results: A secondary intervention was performed in 247 patients (8.7%) at a mean of 12 months after the initial procedure within a follow-Lip period of a mean of 23 12 months. Of these, 57 (23%) transabdominal, 43 (16%) involved an extra-anatomic bypass, and 147 (60%) were by transfemoral approach. The cumulative incidence of secondary interventions was 6.0%, 8.7%, 12%, and 14% at 1, 2, 3, and 4 years, respectively. This corresponded with an annual rate of secondary interventions of 4.6%, which was remarkably lower than in a previously published EUROSTAR study of patients treated before 1999. Type I endoleaks (33% of procedures), migration (16%), and rupture (8.8%) were the most frequent reasons for secondary transabdominal interventions. Graft limb thrombosis was the indication for extra-anatomic bypass (60%). Type I endoleak (17%), type II endoleak (23%), device limb stenosis (14%), thrombosis (23%), and device migration (14%) were the most frequent reasons for secondary transfemoral interventions. Operative mortality was higher after secondary transabdominal interventions (12.3%, P =.007) compared with transfemoral interventions (2.7%). Overall survival was lower in patients with secondary transabdominal (P =.016) and extra-anatomic interventions (P