S. Bonardelli, F. Verzini, N. Rivolta, G. Pagliariccio, Camilla Zanotti, M. Boero, M. Franchin, L. Carbonari, P. Baggi, L. Gibello, G. Parlani, Raffaella Cavi, G. Piffaretti
{"title":"腹主动脉瘤及髂总动脉动脉瘤患者行髂外展肢腔内修复的远期疗效。","authors":"S. Bonardelli, F. Verzini, N. Rivolta, G. Pagliariccio, Camilla Zanotti, M. Boero, M. Franchin, L. Carbonari, P. Baggi, L. Gibello, G. Parlani, Raffaella Cavi, G. Piffaretti","doi":"10.23736/S0021-9509.22.12040-9","DOIUrl":null,"url":null,"abstract":"BACKGROUND\nTo evaluate the long-term outcomes of endovascular aneurysm repair with flared iliac limb grafts in patients with abdominal aortic aneurysm (AAA) and aneurysmal common iliac arteries (CIAs).\n\n\nMETHODS\nThis is a multicenter, retrospective, observational cohort study that involves four tertiary referral hospitals between May 1st 2005 and April 30th 2019. Primary outcomes were freedom from aneurysm-related mortality (ARM), and freedom from iliac-related reintervention.\n\n\nRESULTS\nWe studied 995 aneurysmal iliac limbs in 795 (85.2%) patients who met the inclusion criteria. Median AAA diameter was 55mm (IQR, 51-60). Early mortality occurred in 3 (0.4%) patients. The median of follow-up time was 52 months (IQR, 26-88). Estimated freedom from ARM was 99% ± 0.002 (95%CI: 99-99.9) at 1 year, and 99% ± 0.004 (95%CI: 97.9-99.6) at 5-years. Chronic obstructive pulmonary disease (HR: 6.4, 95%CI: 1.7-24.0, p = 0.006), chronic kidney disease (HR: 5.5, 95%CI: 1.4-21.9, p = 0.016), and the presence of an aneurysmal left CIA (HR: 5.3, 95%CI: 1.0.5-27.4, p = 0.044) was associated with ARM. There were 42 (7.3%) late iliac-related events (limb occlusion, n = 5; iliac-related endoleaks, n = 37). Estimated freedom from iliac-related reintervention was 98% ± 0.003 (95%CI: 97-99) at 1 year, and 95% ± 0.01 (95%CI: 92.7-96.7) at 5-years, which was associated with an aneurysmal right CIA (HR: 2.2, 95%CI: 1.3-3.9; p = 0.005), and age ≥ 78 years (HR: 1.9, 95%CI: 1.01-1.3; p = 0.039).\n\n\nCONCLUSIONS\nEVAR flared iliac limb grafts showed a high rate of freedom from ARM and a low reintervention rate. Owing to these results, it can be a durable and stable alternative for patients aged >78 years.","PeriodicalId":101333,"journal":{"name":"The Journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Long-term outcomes of endovascular aortic repair with flared iliac limb endografts in patients with abdominal aortic aneurysm and aneurysmal common iliac arteries.\",\"authors\":\"S. Bonardelli, F. Verzini, N. Rivolta, G. Pagliariccio, Camilla Zanotti, M. Boero, M. Franchin, L. Carbonari, P. Baggi, L. Gibello, G. Parlani, Raffaella Cavi, G. Piffaretti\",\"doi\":\"10.23736/S0021-9509.22.12040-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\nTo evaluate the long-term outcomes of endovascular aneurysm repair with flared iliac limb grafts in patients with abdominal aortic aneurysm (AAA) and aneurysmal common iliac arteries (CIAs).\\n\\n\\nMETHODS\\nThis is a multicenter, retrospective, observational cohort study that involves four tertiary referral hospitals between May 1st 2005 and April 30th 2019. Primary outcomes were freedom from aneurysm-related mortality (ARM), and freedom from iliac-related reintervention.\\n\\n\\nRESULTS\\nWe studied 995 aneurysmal iliac limbs in 795 (85.2%) patients who met the inclusion criteria. Median AAA diameter was 55mm (IQR, 51-60). Early mortality occurred in 3 (0.4%) patients. The median of follow-up time was 52 months (IQR, 26-88). Estimated freedom from ARM was 99% ± 0.002 (95%CI: 99-99.9) at 1 year, and 99% ± 0.004 (95%CI: 97.9-99.6) at 5-years. Chronic obstructive pulmonary disease (HR: 6.4, 95%CI: 1.7-24.0, p = 0.006), chronic kidney disease (HR: 5.5, 95%CI: 1.4-21.9, p = 0.016), and the presence of an aneurysmal left CIA (HR: 5.3, 95%CI: 1.0.5-27.4, p = 0.044) was associated with ARM. There were 42 (7.3%) late iliac-related events (limb occlusion, n = 5; iliac-related endoleaks, n = 37). Estimated freedom from iliac-related reintervention was 98% ± 0.003 (95%CI: 97-99) at 1 year, and 95% ± 0.01 (95%CI: 92.7-96.7) at 5-years, which was associated with an aneurysmal right CIA (HR: 2.2, 95%CI: 1.3-3.9; p = 0.005), and age ≥ 78 years (HR: 1.9, 95%CI: 1.01-1.3; p = 0.039).\\n\\n\\nCONCLUSIONS\\nEVAR flared iliac limb grafts showed a high rate of freedom from ARM and a low reintervention rate. Owing to these results, it can be a durable and stable alternative for patients aged >78 years.\",\"PeriodicalId\":101333,\"journal\":{\"name\":\"The Journal of cardiovascular surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Journal of cardiovascular surgery\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.23736/S0021-9509.22.12040-9\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of cardiovascular surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.23736/S0021-9509.22.12040-9","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Long-term outcomes of endovascular aortic repair with flared iliac limb endografts in patients with abdominal aortic aneurysm and aneurysmal common iliac arteries.
BACKGROUND
To evaluate the long-term outcomes of endovascular aneurysm repair with flared iliac limb grafts in patients with abdominal aortic aneurysm (AAA) and aneurysmal common iliac arteries (CIAs).
METHODS
This is a multicenter, retrospective, observational cohort study that involves four tertiary referral hospitals between May 1st 2005 and April 30th 2019. Primary outcomes were freedom from aneurysm-related mortality (ARM), and freedom from iliac-related reintervention.
RESULTS
We studied 995 aneurysmal iliac limbs in 795 (85.2%) patients who met the inclusion criteria. Median AAA diameter was 55mm (IQR, 51-60). Early mortality occurred in 3 (0.4%) patients. The median of follow-up time was 52 months (IQR, 26-88). Estimated freedom from ARM was 99% ± 0.002 (95%CI: 99-99.9) at 1 year, and 99% ± 0.004 (95%CI: 97.9-99.6) at 5-years. Chronic obstructive pulmonary disease (HR: 6.4, 95%CI: 1.7-24.0, p = 0.006), chronic kidney disease (HR: 5.5, 95%CI: 1.4-21.9, p = 0.016), and the presence of an aneurysmal left CIA (HR: 5.3, 95%CI: 1.0.5-27.4, p = 0.044) was associated with ARM. There were 42 (7.3%) late iliac-related events (limb occlusion, n = 5; iliac-related endoleaks, n = 37). Estimated freedom from iliac-related reintervention was 98% ± 0.003 (95%CI: 97-99) at 1 year, and 95% ± 0.01 (95%CI: 92.7-96.7) at 5-years, which was associated with an aneurysmal right CIA (HR: 2.2, 95%CI: 1.3-3.9; p = 0.005), and age ≥ 78 years (HR: 1.9, 95%CI: 1.01-1.3; p = 0.039).
CONCLUSIONS
EVAR flared iliac limb grafts showed a high rate of freedom from ARM and a low reintervention rate. Owing to these results, it can be a durable and stable alternative for patients aged >78 years.