1. Midterm outcomes of "wide neck" abdominal aortic aneurysm after open or endovascular repair in two European centers: a propensity score matching analysis.
- Author
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Mascia D, Santoro A, Panuccio G, Tinaglia S, Rohlffs F, Kölbel T, Chiesa R, and Melissano G
- Subjects
- Humans, Male, Aged, Female, Retrospective Studies, Time Factors, Germany, Risk Factors, Middle Aged, Postoperative Complications mortality, Postoperative Complications etiology, Treatment Outcome, Italy, Risk Assessment, Aged, 80 and over, Blood Vessel Prosthesis, Aortic Aneurysm, Abdominal surgery, Aortic Aneurysm, Abdominal mortality, Aortic Aneurysm, Abdominal diagnostic imaging, Endovascular Procedures adverse effects, Endovascular Procedures mortality, Propensity Score, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality, Blood Vessel Prosthesis Implantation instrumentation
- Abstract
Background: The aim of this study was to compare mid-term clinical and morphological outcomes in patients undergoing open (OR) and endovascular aortic repair (EVAR) with a proximal wide neck abdominal aortic aneurysm (WN-AAA)., Methods: Between 2009 and 2014 data of all patients undergoing OR at IRCCS San Raffaele Hospital and EVAR at German Aortic Center Hamburg were retrospectively analyzed. Primary endpoints were aneurysm-related mortality at 5 years, reintervention, and overall mortality. Secondary endpoint was proximal neck enlargement. A 1:1 propensity score matching (PSM) was performed. Survival and freedom from AAA-related reintervention were investigated in matched OR and EVAR group by Kaplan-Meier analysis., Results: Of all OR performed at IRCCS San Raffaele Hospital 70 were found to have a proximal neck >28 mm (mean age: 69.8±7.2 years, 67 [95.71%] male); of all consecutive EVAR performed at German Aortic Center Hamburg, 52 required an endograft size of at least 32 mm (mean age of 73.1±8.7 years, 49 [94.2%] male). After PSM, the study cohort consisted of 30 OR and EVAR. One early mortality was registered in both groups (P=NS). Mid-term freedom from reintervention compared in OR and EVAR, with no statistically significant differences (P=0.979). Eight (15.4%) patients treated with EVAR developed a significant proximal diameter enlargement (≥3 mm) while only 1 (1.4%) patient in the OR group had the same evolution (P<0.01)., Conclusions: In WN-AAA neck enlargement is observed more frequently in patients undergoing EVAR, but reintervention rate was similar in the 2 groups, demonstrating that both options were safe and effective.
- Published
- 2024
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