Аннотация
Objective: The EUROSTAR (European Collaborators on Stent/graft techniques
for aortic aneurysm repair) Registry was established in 1996 to collect
data on the outcome of treatment of patients with infrarenal aortic
aneurysms with endovascular repair. To date, 88 European centers
of vascular surgery have contributed. The purpose of the study was
to evaluate the results of this treatment in the medium term (up
to 4 years) according to the analysis of "hard" or primary end points
of rupture, late conversion, and death. Patients and Methods: Patients
with aortic aneurysms suitable for endovascular aneurysm repair were
notified to the EUROSTAR Data Registry Centre before treatment to
eliminate bias due to selective reporting. The following information
was collected on all patients: (1) demographic details and the anatomic
characteristics of their aneurysms, (2) details of the endovascular
device used, (3) complications encountered during the procedure and
the immediate outcome, (4) results of contrast enhanced computed
tomographic imaging at 3, 6, 12, and 18 months after operation and
at yearly intervals thereafter, and (5) all adverse events. Life
table analysis was performed to determine the cumulative rates of
(1) death from all causes, (2) rupture, and (3) late conversion to
open repair. Risk factors for rupture and late conversion were identified
through regression analysis. Results: By March 2000, 2464 patients
had been registered, and their mean duration of follow-up was 12.19
months (SD, 12.3 months). There were 14 patients with confirmed rupture
of their aneurysms. The cumulative rate (risk) of rupture was approximately
1% per year. Emergency surgery was undertaken in 12 (86%) patients,
of whom five (41.6%) survived. Two patients who were not treated
surgically also died, which resulted in an overall death rate of
64.5% (9/14) of the patients. Significant risk factors for rupture
were proximal type I endoleak (P = .001), midgraft (type III) endoleak
(P = .001), graft migration (P = .001), and postoperative kinking
of the endograft (P = .001). Forty-one patients underwent late conversion
to open repair with a perioperative mortality rate of 24.4% (10/41).
The cumulative rate (risk) of late conversion was approximately 2.1%
per year. Risk factors (indications) for late conversion were proximal
type I endoleak (P = .001), midgraft (type III) endoleak (P = .001),
type II endoleak (P = .003), graft migration (P = .001), graft kinking
(P = .001), and distal type I endoleak (P = .001). Conclusions: Endovascular
repair of infrarenal aortic aneurysms with the first- and second-generation
devices that predominated in this study was associated with a risk
of late failure, according to an analysis of observed hard end points
of 3% per year. Action taken to address the risk factors identified
by the study may improve results in the future
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