Endovascular aortic repair of infrarenal abdominal aortic aneurysm: a 10-year single center outcomes / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcome after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) in single center.</p><p><b>METHODS</b>A total of 711 AAA patients treated by EVAR in Department of Vascular Surgery, People's Liberation Army General Hospital and met the inclusion criteria from January 2004 to June 2014 were followed-up and analyzed. There were 612 male and 99 female patients, with a mean age of (69±13) years in this study group. The primary outcome of the study was all-cause mortality, secondary outcome included procedural data, intervention-related morbidity and secondary therapeutic procedures. The endpoint was death. Kaplan-Meier survival analysis were used to analyze long-term survival and cumulative probability of intervention related morbidity. Cox proportional hazards regression was used to analyze factors influenced the survival. Multivariable analysis were adjusted for covariates.</p><p><b>RESULTS</b>There were 74.8% of total patients followed up. The longest follow-up period was 10.4 years (mean 3.8 years). For the primary outcome of all-cause mortality, 140 deaths occurred. Intervention related morbidity was 9.3%, secondary therapeutic procedures was 5.3%.The Kaplan-Meier survival curve showed that cumulative survival is 78% (95% CI: 74% to 82%) in 5 years, 67% (95% CI: 61% to 74%) in 10 years and the cumulative probability of intervention related morbidity is 10.5% (95% CI: 7.3% to 13.7%) in 5 years, 19.3% (95% CI: 11.9% to 26.0%) in 10 years. Cox proportional hazards regression showed that age>75 years, American Society of Anesthesiologists classification III or IV, smoking, diabetes significantly increase the risk of long-term all-cause mortality, while hypertension significantly decreases the risk.</p><p><b>CONCLUSIONS</b>Long-term outcome after EVAR of AAA in the study is similar to those advanced studies.The management of risk factors would improve the prognosis of these patients.</p>

Abdominal aortic aneurysm treated by endovascular stent graft and conventional surgical repair for overweight and obesity patients: a comparison early result / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the outcomes in overweight and obesity patients with abdominal aortic aneurysm (AAA) treated with elective open or endovascular repair (EVAR).</p><p><b>METHODS</b>The clinical data of 52 patients with AAA treated by EVAR (EVAR group, n=17) and conventional surgical repair (open group, n=54) were analyzed retrospectively. Overweight was defined as a body mass index (BMI) between 24 kg/m2 and 28 kg/m2, obesity was defined as a BMI 28 kg/m2. Patients' conditions, operative time, blood loss, function recovery and complications were compared. A two-tailed Student's t-test or rank sum test was used to compare measurement data between the two groups. χ2 test or Fisher exact probability test was used to compare quantitative data between the two groups.</p><p><b>RESULTS</b>No significant difference were observed in gender, age, other disease, anesthesia risk category, aneurysm type, the maximum aneurysm diameter, and mortality rate between the groups (P>0.05). All patients had success of surgical procedures. Compared with open group the EVAR group had significant reductions in operative time ((449±174) minuets vs. (140±36) minuets), blood loss ((1.8±1.9) L vs. (1.7±1.2) L), units of blood transfusion ((5.3±5.2) units vs. 0), intravenous fluids ((3.3±1.6) L vs. (1.6±1.6) L), need for ventilation ((26.2±10.6) hours vs. (2.3±1.4) hours), intensive care unit stay ((5.2±1.3) days vs. (1.4±0.5) days) and length of stay ((17±9) days vs. (7±3) days) (F=9.932 to 44.816, all P<0.05). Six cases of complications was observed in open group during perioperative, while 9 cases of complications were observed in EVAR group. The difference was significant (χ2=9.572, P=0.008) which open group was significantly higher than the EVAR group. Two patients died during perioperative in open group, however, the EVAR group had no deaths occurred. All complications were connected with the interventional technique. Endoleak was the chief complication after operation. After Follow-up the main complications of infection (n=2), wounds (n=2) and abdominal hernia (n=2) based for open group was observed, and the main complications for EVAR group was endoleak (1 case of type I, 3 cases of type II).</p><p><b>CONCLUSION</b>EVAR may be preferable in overweight and obesity patients with AAA in the short term.</p>