Data di Pubblicazione:
2011
Citazione:
Endovascular aneurysm repair: experience of 12 years in a single institution / D. Mazzaccaro, A.M. Settembrini, G. Malacrida, S. Stegher, M.T. Occhiuto, F. Sorba, D.G. Tealdi, G. Nano. ((Intervento presentato al 60. convegno ESCVS International Congress tenutosi a Mosca nel 2011.
Abstract:
Objective: In the last 10 years endovascular repair has proved to be an alternative
to open surgery for the treatment of abdominal aortic aneurysms.
Early and mid-term results for EVAR are known throughout the literature,
otherwise long-term results have been published recently. We report our
experience in the last 12 years evaluating early and long-term results of
applying this technique.
Methods: From January 1998 to June 2010, 494 of 1237 patients (39.9%)
underwent EVAR in our centre for an abdominal aortic aneurysm. Most
EVARs were performed on males (92.9%). Patients’ median age was 73 years
(range 49–91 years). All procedures were performed by experienced Vascular
Surgeons in Operatory Room with anesthesiological assistance. After the
procedure, patients were routinely followed-up at two months with a duplex
ultrasound, at six months with a contrast-enhanced CT-scan, then at 12
months and every year with a duplex ultrasound. Median follow-up was 68
months (range 1–144 months). Data were collected about perioperative and
long-term cardiac and renal complications, thrombosis, surgical conversions,
endoleaks, death and death from aortic rupture. All data were analysed
using Sigma Stat 3.0.
Results: The procedure was successfully ended in 488 patients (98.8%).
Immediate surgical conversion was necessary in six patients (1.2%) for acute
thrombosis of the graft (one patient), rupture of iliac artery (2), incomplete
opening of the graft (3). At 30 days we observed six deaths (1.2%), 12 acute
renal failures (2.4%), three graft thrombosis (0.6%) and six (1.2%) myocardial
infarction (MI). Long-term results were collected on 391 patients (81.1%).
We observed five MI (1.2%), 10 chronic renal failures (2.5%), eight graft
thrombosis (2.0%), 77 deaths (19.7%), 31 type I endoleaks (7.9%), 12 type II
endoleaks (3.0%), three type III endoleaks (0.7%). There were not any type
IV, V nor VI endoleaks. Reintervention was necessary in 45 patients (11.5%);
eight of them (2.0%) were late surgical conversion, all within 60 months
from the first intervention. Aortic rupture occurred in five patients (1.2%),
three of them were fatal. At 144 months 32.8%+4.4% of patients were alive
and free from any major adverse events, 5.2%+5.6% of patients were alive,
97.5%+1.1% were free from aortic rupture and 65.4%+5.4% were free from
graft-related complications.
Conclusions: In our experience EVAR was safe and effective both at early and
at long-term results, especially in relation to the prevention of late aortic
rupture and aneurysm-related mortality, which are the main outcomes of
endovascular treatment.
Tipologia IRIS:
14 - Intervento a convegno non pubblicato
Elenco autori:
D. Mazzaccaro, A.M. Settembrini, G. Malacrida, S. Stegher, M.T. Occhiuto, F. Sorba, D.G. Tealdi, G. Nano
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