Should We Modify Our Indications After the EVAR-2 Trial Conclusions?

详细信息    查看全文

• 作者：Jonathan Sobocinski ; Bl ; ine Maurel ; Pascal Delsart ; Piervito d'Elia ; Matthieu Guillou ; Filippo Maioli ; Cé ; line Perot ; Auré ; lia Bianchini ; Richard Azzaoui ; Claire Mounier-Vehier ; Sté ; phan Haulon
• 刊名：Annals of Vascular Surgery
• 出版年：2011
• 出版时间：July 2011
• 年：2011
• 卷：25
• 期：5
• 页码：590-597
• 全文大小：277 K

文摘

Background

To compare the results of the endovascular aneurysm repair (EVAR) in patients considered as unfit for surgery in a “high volume” center with the EVAR-2 trial results.

Methods

In our center, between January 2006 and December 2008, 469 endovascular aorta treatments were performed in high-risk patients. All the data were prospectively collected in a database. Among 469 patients, we selected 191 patients considered as unfit for open surgery (group 1) corresponding to the EVAR trial criteria. Variables such as postoperative mortality at 30 days and 1 year, complications rates, as well as early and late redo surgery were evaluated. Long-term pharmacological treatment before surgery was listed. These results were compared with the EVAR trial (group 2). Survival during the follow-up was calculated according to the Kaplan–Meier method.

Results

Mortality at 30 days was 1.6 % and 9 % in groups 1 and 2, respectively (p = 0.002). Global complication rate was 44 % and 43 % in groups 1 and 2, respectively (p = 0.52). Over the follow-up period, the redo surgery rate was 13 % and 26 % in groups 1 and 2, respectively (p = 0.0102). In our cohort, the survival rate at 2 years was 84 % with a residual number of 102 patients. Before surgery, a long-term antiplatelet treatment was prescribed in 89 % and 58 % of the patients and statins in 74 % and 39 % of the patients in groups 1 and 2, respectively (p < 0.0001).

Conclusion

The EVAR-2 trial conclusions are in opposition to the practice of French vascular surgeons. Endovascular treatment of abdominal aortic aneurysms in high-risk patients is justified. This study confirms the importance of a multidisciplinary treatment for high-risk patients in high-volume centers.