Should patients with challenging anatomy be offered endovascular aneurysm repair?
Should patients with challenging anatomy be offered endovascular aneurysm repair?
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DOI：
10.1016/s0741-5214(03)00896-6
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发表时间：
2003-11-01
影响因子：
4.3
通讯作者：
Ouriel, K
中科院分区：
文献类型：
--
作者：
Greenberg, RK;Clair, D;Ouriel, K
目标。对于开放修复的高生理风险和血管内修复的解剖风险高的患者，腹主动脉瘤的治疗存在争议。我们比较了由于解剖结构（颈短或成角）、严重闭塞性疾病或双侧髂动脉瘤（A 组）而导致的高风险患者（A 组）和低风险患者（B 组）的结果。 材料和方法：将 1998 年 10 月至 2002 年 3 月期间接受 Zenith 血管内移植物治疗的高解剖风险患者（A 组）与参加前瞻性多中心试验的低解剖风险患者（B 组）进行比较。比较的变量包括总体死亡率、二次干预的需要、内漏的发生以及动脉瘤囊直径的变化。使用chi(2) 检验、Student t 检验和比例分析来评估数据。结果：评估了 493 名患者（A 组，141 名；B 组，352 名）的数据。平均随访时间为 9 个月（范围：1-24 个月）。 A 组和 B 组的围手术期死亡率相似（0.7% vs 1%）。具有高危解剖结构的患者内漏频率较高（25% vs 11%），但差异并不显着（P >.06）。即使没有内漏，A 组的动脉瘤收缩速度也较慢（P
Objectives. Treatment of abdominal aortic aneurysm is controversial in patients at high physiologic risk for open repair and high anatomic risk for endovascular repair. We compared outcome in patients at high risk because of anatomy (short or angulated neck), severe occlusive disease, or bilateral iliac aneurysms (group A) with outcome in patients at low risk (group B).Material and methods: Patients at high anatomic risk who underwent treatment between October 1998 and March 2002 with the Zenith endovascular graft (group A) were compared with patients at low anatomic risk enrolled in a prospective multicenter trial (group B). Variables compared included overall mortality, need for secondary interventions, development of endoleak, and change in aneurysm sac diameter. The chi(2) test, Student t test, and proportions analysis were used to assess the data.Results: Data for 493 patients (group A, 141; group B, 352) were evaluated. Mean follow-up was 9 months (range, 1-24 months). Perioperative mortality was similar for groups A and B (0.7% vs 1%). Frequency of endoleak was higher in patients with high-risk anatomy (25% vs 11%), but not significantly so (P >.06). The rate of aneurysm shrinkage, even in the absence of endoleak, was slower in group A (P