Mid-and long-term follow up of endovascular aortic repair for infrarenal abdominal aortic aneurysms with diabetes mellitus / 中华普通外科杂志

Objective To evaluate the outcome of the endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) with diabetes mellitus (DM) and analyze the factors that influence its mid-long-term curative effect.Methods From Jan 2004 to Jun 2014,follow-up data of 103 AAA patients with DM treated with EVAR was analyzed retrospectively.Results Effective follow-up visits were conducted on 88 patients (85.43％).The patients were tracked for an median of 3.59 years,with the longest follow-up 10.32 years.25 deaths occurred and the all-cause mortality rate was 24.3％.6 cases had intervention-related complications (5.8％),including endoleaks,thrombosis,embolism,infection,false aneurysms.2 secondary interventions were conducted on 2 patients.The five-year cumulative survival rate was 70％ and the ten-year cumulative survival rate was 61％.Conclusion EVAR is safe for AAA patients with DM.

Midterm outcomes of in situ fenestration for aortic arch vessels / 中华普通外科杂志

Objective To evaluate midterm outcomes of thoracic endovascular aortic repair (TEVAR) with in situ fenestration (ISF) to revascularize the aortic arch vessels.Methods From Feb 2012 to Dec 2014,10 patients underwent TEVAR with aortic arch vessels revascularized via ISF.There were 6 patients of thoracic aortic aneurysms (TAA) and 4 of type B aortic dissection (TBAD).Patients were followed for all-cause mortality,endoleak of post-TEVAR,integrity and patency of aortic endograft and branch vessels.Results Totally 11 branch vessels [10 left subclavian arteries (LSA),1 left common carotid artery (LCA)] via ISF were revascularized in 10 patients.Patients were followed-up for 24-55 mouths,mean of 42.80 months.1 TAA patient died in 2 years post-TEVAR unrelated to the operation.All fenestrations remained patent,and there were no endoleaks and no occlusion,compression,or fracture of stents.There were no postoperative strokes and left upper limbs ischemia.1 patient had distal aortic endograft pseudoaneurysms formation in 2 years post-TEVAR and underwent reTEVAR treatment.Conclusion Aortic arch vessels revascularization via ISF in TEVAR is safe and feasible.Midterm outcomes is satisfactory.

Comparison of mid-term outcome after EVAR between symptomatic and asymptomatic AAAs / 中华普通外科杂志

Objective To compare the mid-term outcomes after endovascular repair of symptomatic abdominal aneurysms (S-AAAs) and elective non-symptomatic AAAs (E-AAAs).Methods A total of 230 non-ruptured AAA patients treated by EVAR who met the inclusion criteria from January 2008 to February 2013 were followed up.Results A total of 160 cases were followed-up,mean follow-up time was 22.7 months.The prevalence of cardiovascular disease in E-AAAs group was significantly higher than that in S-AAAs group.E-AAAs patients had shorter ICU stay time [(1.26 ± 3.13) d vs.(0.07 ± 0.40) d,P ＜0.01] compared with S-AAAs patients.The 36 month survival rate was 81％ (95％ CI 0.72-0.91) vs.72％ (95％ CI 0.56-0.91) respectively.Conclusions There is no difference in mid-term outcome between symptomatic AAA and elective non-symptomatic AAA patients treated by EVAR.

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>

Comparative study of perioperative outcome between endovascular repair and open surgical repair for ruptured abdominal aortic aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the perioperative outcome between the endovascular repair (EVAR) and open surgical repair (OSR) for ruptured abdominal aortic aneurysm.</p><p><b>METHODS</b>From January 2006 to January 2013, totally 66 patients with ruptured abdominal aortic aneurysm (rAAA) treated by surgery were retrospectively analyzed in Department of vascular surgery, People's Liberation Army General Hospital. According to the repair method, all the subjects were divided into EVAR group and OSR group. EVAR group included 40 patients, 30 patients were male, 10 patients were female, aged from 47 to 78 with a mean of (71 ± 7) years. OSR group included 26 patients, 21 patients were male, aged from 45 to 87 with a mean of (72 ± 9) years. The difference of the operation time, the amount of suspended red blood cells, ICU stay time, case fatality rate, adverse event rate and the difference of the two intervention rate were compared between the 2 groups by χ(2) test and t test.</p><p><b>RESULTS</b>There were significant differences between the 2 groups in operation time, the amount of suspended red blood cells, ICU stay time, case fatality rate, adverse event rate ((183 ± 44) minutes vs. (384 ± 108) minutes, t = -10.59, P = 0.00; (0.4 ± 0.8) units vs. (1.1 ± 1.8) units, t = -2.19, P = 0.03; (3.0 ± 1.8) d vs. (8.5 ± 5.1) d, t = -6.34, P = 0.00; 20.0% (8/40) vs. 46.2% (12/26), χ(2) = 5.10, P = 0.02; 25.0% (10/40) vs. 53.8% (14/26), χ(2) = 5.67, P = 0.02). There were no significant differences in frozen plasma quantities and the two intervention rate between the 2 groups (t = -1.98, P = 0.05; χ(2) = 0.49, P = 0.48).</p><p><b>CONCLUSIONS</b>EVAR decreases the perioperative mortality and adverse event of rAAA compared with OSR. More studies are necessary to compare the middle and long-outcome between EVAR and OSR of rAAA.</p>

Comparison of perioperative outcome after endovascular repair between symptomatic and asymptomatic abdominal aortic aneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the perioperative outcome after endovascular repair (EVAR) of symptomatic abdominal aneurysms (S-AAAs) and elective non-symptomatic AAAs (E-AAAs).</p><p><b>METHODS</b>From January 2008 to February 2013, a total of 230 non-ruptured AAA patients treated by EVAR met the inclusion criteria. S-AAAs were present in 43 (18.7%) patients, 40 patients were male, 3 patients were female, aged (69 ± 10) years and E-AAAs in 187 (81.3%) patients, 162 of which were male, the other 25 patients were female, aged (71 ± 9) years. Patients were followed up at 1 month after EVAR. The primary outcome of the study was perioperative mortality, secondary outcome included procedural data and major perioperative adverse events.</p><p><b>RESULTS</b>At baseline, there were no differences in age, gender, American Society of Anesthesiologists classification score, and basic diseases. S-AAA patients had larger aneurysms on average (6.00 (1.97) cm vs. 5.10 (1.7) cm, Z = 2.51, P = 0.01). S-AAA patients had shorter preoperative hospitalization (5.00 (5.0) days vs. 7.00 (4.0) days, Z = 1.86, P = 0.02). No differences in the perioperative mortality, respectively, 0 and 1.1% (P = 0.66). Technical success and clinical success were all 100% and the other procedure data was similar (P > 0.05). The occurrence of major adverse events, including mortality, within the 30-day after EVAR were similar between S-AAA and E-AAA patients (0 vs. 2.1%, P = 0.43).</p><p><b>CONCLUSIONS</b>There is no difference in perioperative outcome between S-AAA and elective E-AAA patients treated by EVAR. More study is needed to compare the middle and long-outcome between S-AAAs and E-AAAs after EVAR.</p>

The risk factors of systemic inflammatory response syndrome after endovascular aortic repair of the aortic aneurysm / 中华普通外科杂志

Objective To explore the relationship between the endovascular aortic repair (EVAR)in patients with abdominal aortic aneurysm (AAA) and postoperative systemic inflammatory response syndrome (SIRS).Methods In this study,93 AAA patients undergoing EVAR were enrolled.Analysis was performed to evaluate the incidence of SIRS during peri-operation period.Logistic multiple regression analysis was performed to determine the parameters predicting SIRS.Results The incidence of SIRS was 58.1％.Aneurysm size,mural thrombus,iliac artery lesion,number of stent,operating time,volume of contrast agent,blood loss and length of stay were all significantly correlated with SIRS (P ＜ 0.05).In a logistic regression model,history of kidney disease or operation,aneurysm size,ruptured aneurysm and number of stents were strongly and independently associated with SIRS.Conclusions SIRS is common in AAA patients after EVAR.Optimizing treatment strategies avoiding risk factors for SIRS benefits AAA patients.