One Year Stable Sac Predicts Worse Overall Survival and Mid-Term Outcomes Compared with Sac Regression after Complex Abdominal Aortic Aneurysm Repair with Fenestrated/Branched Endografts.
Davide Esposito, Tuukka Kaartama, Martina Bastianon, Sani Laukontaus, Walter Dorigo, Amjad Belramman, Raffaele Pulli, Alun H Davies, Maarit Venermo, Giovanni Pratesi
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引用次数: 0
Abstract
Objective: This multicentre, retrospective, observational study investigated the correlation of sac dynamics and outcomes in patients with complex abdominal aortic aneurysms (AAAs) after fenestrated/branched endovascular repair (FB-EVAR).
Methods: Consecutive patients undergoing FB-EVAR for short neck infrarenal, juxtarenal, pararenal, and paravisceral AAAs between 2015 and 2022 were included. Based on one year sac dynamics, patients with sac expansion were excluded. Comparisons were made between patients with sac regression and those with sac stability. Primary endpoints included overall survival, freedom from re-interventions, and last follow up sac regression. Secondary outcomes included freedom from aorta related death, freedom from any endoleak, and freedom from cumulative adverse events.
Results: The study cohort consisted of 98 patients, 36 with sac regression and 62 with sac stability at one year. Median follow up was 34 months (interquartile range 32). The four year estimated overall survival was lower for patients with sac stability (57.2 vs. 87.5%, p = .029), which also demonstrated a lower freedom from re-interventions (89.2 vs. 94.4%, p = .11). The four year estimates of last follow up sac regression were statistically significantly higher in those with initial sac regression (46 vs. 94.7%, p < .001). Cox regression analysis identified treatment of all renal/visceral vessels (hazard ratio [HR] 2.18, p = .035) and sac regression at one year (HR 2.37, p = .015) as independent predictors of follow up sac regression. Conversely, the presence of an endoleak (HR 0.31, p = .050) predicted the absence of sac regression. One year sac regression was an independent predictor of survival (HR 3.11, p = .050). Freedom from aorta related death (96.6 vs. 100%, p = .263), endoleak (66.3 vs. 90.2%, p = .035), and cumulative adverse events (89.7 vs. 94.4%, p = .08) were in favour of patients with sac regression.
Conclusion: Sac dynamics correlate with midterm outcomes after FB-EVAR for complex AAAs. One year sac regression predicted better outcomes and survival, suggesting the need for closer surveillance in patients with stable sacs.
目的：本多中心、回顾性、观察性研究探讨复杂腹主动脉瘤（AAAs）开窗/分支血管内修复（FB-EVAR）后囊动力学与预后的相关性。方法：纳入2015年至2022年间连续接受FB-EVAR治疗短颈肾下、肾旁、肾旁和肝旁AAAs的患者。根据一年的囊动态，排除囊扩张患者。将囊退化患者与囊稳定患者进行比较。主要终点包括总生存期、再次干预的自由度和最后随访的囊回归。次要结局包括无主动脉相关死亡、无任何内源性渗漏和无累积不良事件。结果：研究队列包括98例患者，其中36例囊退化，62例囊稳定。中位随访时间为34个月（四分位数间距32）。囊腔稳定患者的四年估计总生存率较低（57.2比87.5%,p = 0.029），这也表明再次干预的自由度较低（89.2比94.4%,p = 0.11）。最后一次随访囊回归的4年估计值在初始囊回归组中有统计学意义（46比94.7%,p < 0.001）。Cox回归分析发现，所有肾/内脏血管的治疗（风险比[HR] 2.18, p = 0.035）和一年的囊腔回归（风险比[HR] 2.37, p = 0.015）是随访囊腔回归的独立预测因素。相反，内漏的存在（HR 0.31, p = 0.050）预示着囊性回归的缺失。1年囊回归是生存的独立预测因子（HR 3.11, p = 0.050）。无主动脉相关死亡（96.6 vs 100%, p = 0.263）、内漏（66.3 vs 90.2%, p = 0.035）和累积不良事件（89.7 vs 94.4%, p = 0.08）有利于囊退化患者。结论：Sac动力学与复杂AAAs FB-EVAR的中期预后相关。一年的囊回归预测更好的结果和生存，提示需要对稳定囊的患者进行更密切的监测。
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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