RESUMO
OBJECTIVE: To describe the factors associated with survival 20 years after endovascular treatment of an abdominal aortic aneurysm (AAA) in a single center. METHODS: Prospective cohort of asymptomatic patients with an infrarenal aortic aneurysm treated with a bifurcated endovascular graft (Talent) between June 1997 and August 2008. Cox proportional hazard multivariable regression was used for analysis of independent risk factors for survival. Kaplan-Meier curves were done with the long-rank test. P < .05 was considered significant. RESULTS: We followed 229 patients, 184 without an endoleak and 45 with an endoleak. Ages ranged between 52 and 89 years, and the mean diameter of the aneurysm was 59.51 ± 14.6 mm. Implantation of the endovascular graft was possible in 99% of the patients. The 30-day mortality rate was 3.4%. In the Cox regression, age <73 years (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.27-0.64), aneurysm size ≤55 mm (HR, 0.62; 95% CI, 0.40-0.95), male sex (HR, 0.17; 95% CI, 0.05-0.52), American Society of Anesthesiologists surgical risk category I and II vs III and IV (HR, 0.51; 95% CI, 0.34-0.75), and aneurysm size reduction ≤3 mm after treatment (HR, 2.23; 95% CI, 1.11-4.51) were significantly correlated with the survival of the patients followed in this long-term case series. CONCLUSIONS: This 20-year prospective cohort included patients with an AAA treated with a bifurcated endovascular graft (Talent) at a university hospital in Brazil. This study supports that sex, age, aneurysm size, aneurysm size reduction, and American Society of Anesthesiologists surgical risk category are significantly correlated with patient survival after endovascular treatment of the AAA.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Brasil , Causas de Morte , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/mortalidade , Feminino , Hospitais Universitários , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To report a 10-year prospective study of patients submitted to endovascular treatment for infrarenal abdominal aortic aneurysms (AAA). METHODS: Between June 1997 and June 2007, 337 patients (284 men; mean age 72.5+/-7.4 years, range 52-89) with AAA underwent endovascular aneurysm treatment (EVAR) with implantation of Talent stent-grafts. The mean AAA diameter was 59.0+/-14.4 mm. All patients were clinically followed using computed tomography in the immediate post surgery period (15-30 days), after 6 months, and yearly thereafter. Plain abdominal radiography was performed yearly to assess the metallic components of the stent-grafts. Data concerning endoleaks, secondary procedures, and aneurysm diameter behavior were evaluated. Survival was evaluated using Kaplan-Meier estimates. RESULTS: Endoprosthesis implantations were successful in 99.1% (334/337). There were 2 surgical conversions, and the delivery system could not be inserted in 1 female patient. The perioperative mortality was 3.9% (n = 13). Nineteen (5.7%) aneurysms showed endoleaks during the first 30 days (6 type I and 13 type II); 5 type I and 3 type II endoleaks were repaired (secondary clinical success of 92.6%). Another 15 late endoleaks were detected (4 type I, 5 type II, 3 type III, 1 type IV, 2 endotension), for a total of 34 (10.2%) endoleaks. Follow-up (mean 58.7 months, range 12-120) was available in 273 (81.0%) patients. During this time, there were 2 (0.7%) aneurysm ruptures, 1 due to type III endoleak and the other to endotension. Over the course of the study, 75 patients died; the estimated survival rates by the Kaplan-Meyer analysis were 67.3% after 5 years and 54.2% after 7 years. The mean AAA diameter decreased to 45.7+/-18.4 mm (p<0.001 versus mean postoperative diameter) at 60 months and to 37.8+/-15.0 mm at 120 months (p<0.019). CONCLUSION: Endovascular aneurysm treatment with the Talent stent-graft has proven to be effective in the prevention of AAA rupture into the long term.