Aneuryzma abdominální aorty – dlouhodobé výsledky léčby
Authors:
V. Třeška; B. Čertík; V. Kuntscher; R. Šulc; J. Moláček; K. Houdek; F. Šlauf *; M. Novák *; I. Třešková; A. Ňaršanská
Authors‘ workplace:
Chirurgická klinika FN a LF UK v Plzni, přednosta: prof. MUDr. Vladislav Třeška, DrSc.
; Radiodiagnostická klinika FN a LF UK v Plzni
*
Published in:
Rozhl. Chir., 2010, roč. 89, č. 5, s. 300-305.
Category:
Monothematic special - Original
Overview
Objective:
To evaluate the single center experience in the treatment of patients with AAA.
Methods:
586 patients undergoing open resection (OR) and EVAR (2000–2009). The average age was 72.2 Ī 7.7 years. AAA diameter was 8.3 cm (range 5.0–13.1cm). 451 (76.9%) patients had asymptomatic AAA, 135 (23.1%) RAAA. 448 patients (76.5%) suffered from various co-morbidities. 430 (73.4 %) OR, 156 (26.6%) EVAR and 52 (8.9%) one staged procedure (for concomitant diseases) was performed.
Results:
30 days mortality rate of elective OR and EVAR was 6.2, resp. 2.9% (n.s.) versus 36.6% of RAAA (p < 0.0001). 30 days mortality rate of one staged and single procedure was 19.5, resp. 3.6% (p < 0.0001). 30 days morbidity rate was in the whole group 52.1% (80.7% in RAAA x 43.4% in asymptomatic AAA – p < 0.0001), in one-stage procedures 60.8% x 51.1% in single procedures – n.s., 45.1% in OR x 39.0% in EVAR – n.s. Redo procedures were significantly higher in EVAR x OR in the long-term period after primary procedure. 1-, 3-, 5-, and 8 years survival of patients with asymptomatic AAA and RAAA was 91.6, 85.9, 81.1 and 73.6%, resp. 54.9, 48.9, 45.9 and 43.5 years (p < 0.0001). 1-, 3-, and 5 years patients survival with single versus one staged procedures was 85.5, 80.5 and 71.0% versus 71.1, 68.0 and 74.6% (n.s.). 1-, 3-, and 5- years patients survival after OR or EVAR was 91.2, 87.1 and 80.6%, resp. 90.7, 79.9 and 74.6 % (n.s.). The significant influence on patients long-term survival had RAAA, age of patients, postoperative complications and one stage procedures.
Conclusion:
High percentage of polymorbidity was the cause of the significant 30days postoperative mortality of patients after OR. EVAR and OR have similar long-term results. One staged procedures should be used very carefully in selected patients due to the higher mortality rate and worse long-term patients survival.
Key words:
abdominal aortic aneurysm – treatment – long-term results
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