Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.011717
Jornal Vascular Brasileiro
Original Article

Fatores de risco associados e sobrevida em curto e médio prazo de pacientes submetidos a correção aberta e endovascular de aneurisma de aorta abdominal

Risk factors and short and medium-term survival after open and endovascular repair of abdominal aortic aneurysms

Seleno Glauber de Jesus-Silva, Victor Rodrigues de Oliveira, Melissa Andreia de Moraes-Silva, Arturo Eduardo Krupa, Rodolfo Souza Cardoso

Downloads: 0
Views: 135

Resumo

Contexto: Os aneurismas de aorta abdominal (AAA) infrarrenal apresentam alta morbimortalidade associada à ruptura e podem ser tratados por cirurgia aberta ou endovascular. Objetivos: Analisar os fatores de risco e a sobrevida associados aos métodos cirúrgico e endovascular no tratamento do AAA. Métodos: Estudo retrospectivo e longitudinal envolvendo 41 pacientes submetidos à correção endovascular ou aberta do AAA, de forma eletiva ou emergencial, no período de 48 meses. Foi realizada análise de comorbidades pré-operatórias, sobrevida em 30 dias e 1 ano, mortalidade hospitalar, tempo de internação, hemotransfusões, duração da cirurgia e ocorrência de insuficiência renal aguda. A estatística inferencial e a análise de sobrevida foram realizadas considerando intervalo de confiança de 95% e p < 0,05 como significante. Resultados: Dos 41 pacientes, 12 foram submetidos à correção aberta e 29, à endovascular. A maioria eram homens (75%), com média de idade de 71 anos (mín. 56, máx. 90 anos). Não houve diferenças de fatores de risco entre os grupos. A sobrevida global dos pacientes foi diferente para os tratamentos aberto e endovascular, tanto em 30 dias (37 vs. 72%; p = 0,01) quanto em 360 dias (37 vs. 67%; p = 0,01), respectivamente. A sobrevida dos casos eletivos em 30 dias (71 vs. 76%; p = 0,44) e 360 dias (ambas 71%; p = 0,34) foram semelhantes. O reparo endovascular apresentou menor tempo de internação (3,0 vs. 4,4 dias; p = 0,02) e duração da cirurgia (111 vs. 163 min; p = 0,005) quando comparado à cirurgia aberta. Conclusões: Não houve diferença na sobrevida em curto e médio prazo dos pacientes com AAA tratados de forma eletiva pelas técnicas endovascular e cirúrgica. Menor tempo de internação e duração da cirurgia foram observados no tratamento minimamente invasivo.

Palavras-chave

aneurisma da aorta abdominal; fatores de risco; implante de prótese vascular; análise de sobrevida

Abstract

Background: Infrarenal abdominal aortic aneurysms (AAA) are responsible for high rates of rupture-associated morbidity and mortality and can be treated by open or endovascular surgery. Objectives: To analyze risk factors and survival associated with surgical and endovascular AAA treatment methods. Methods: A retrospective, longitudinal study involving 41 patients who underwent endovascular or open AAA repair, whether elective or emergency, over a 48-month period, with analysis of preoperative comorbidities, 30-day and 1-year survival, in-hospital mortality, length of hospital stay, transfusion of blood products, duration of surgery, and development of acute kidney failure. Inferential statistics and survival analysis considered a 95% CI and p < 0.05 as significant. Results: Twelve of the 41 patients were treated with open surgery and 29 with endovascular techniques. The majority were male (75%), with an average age of 71 (range: 56 – 90 years). There were no differences in demographic or risk factors between the groups. Overall survival rates for open and endovascular repair were different for both 30 days (37 vs. 72%, p = 0.01) and 360 days (37 vs. 67%, p = 0.01). However, survival rates in elective cases were similar at 30 days (71 vs. 76%, p = 0.44) and 360 days (both 71%, p = 0.34). Endovascular repair showed shorter length of hospital stay (3.0 vs. 4.4 days; p = 0.02) and duration of surgery (111 vs. 163 min; p < 0.01) compared to open repair. Conclusions: There was no difference in short- or medium-term survival of AAA patients treated electively with endovascular or open surgery. Hospital stays and duration of surgery were both shorter with minimally invasive treatment.

Keywords

abdominal aortic aneurysm; risk factors; blood vessel prosthesis implantation; survival analysis

References

1. Puech-Leão P, Molnar LJ, Oliveira IR, Cerri GG. Prevalence of abdominal aortic aneurysms--a screening program in São Paulo, Brazil. Sao Paulo Med J. 2004;122(4):158-60. http://dx.doi.org/10.1590/S1516-31802004000400005. PMid:15543370.

2. Gawenda M, Brunkwall J. Ruptured abdominal aortic aneurysm: the state of play. Dtsch Arztebl Int. 2012;109(43):727-32. http://dx.doi.org/10.3238/arztebl.2012.0727. PMid:23181137.

3. Chaikof EL, Brewster DC, Dalman RL, et al. The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines. J Vasc Surg. 2009;50(4):S2-S49. http://dx.doi.org/10.1016/j.jvs.2009.07.002.

4. Moll FL, Powell JT, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg. 2011;41(S1):S1-58. http://dx.doi.org/10.1016/j.ejvs.2010.09.011.

5. Novero ER, Metzger PB, Angelieri F, et al. Correção endovascular do aneurisma da aorta abdominal: análise dos resultados de único centro. Radiol Bras. 2012;45(1):1-6. http://dx.doi.org/10.1590/S0100-39842012000100003.

6. Mastracci TM, Cinà CS. Canadian Society for vascular surgery. Screening for abdominal aortic aneurysm in Canada: review and position statement of the Canadian Society for Vascular Surgery. J Vasc Surg. 2007;45(6):1268-76. http://dx.doi.org/10.1016/j.jvs.2007.02.041. PMid:17543696.

7. Chuter TA, Reilly LM, Faruqi RM, et al. Endovascular aneurysm repair in high-risk patients. J Vasc Surg. 2000;31(1Pt 1):122-33. http://dx.doi.org/10.1016/S0741-5214(00)70074-7. PMid:10642715.

8. Sicard GA, Zwolak RM, Sidawy AN, White RA, Siami FS. Society for Vascular Surgery Outcomes Committee. Endovascular abdominal aortic aneurysm repair: long-term outcome measures in patients at high-risk for open surgery. J Vasc Surg. 2006;44(2):229-36. http://dx.doi.org/10.1016/j.jvs.2006.04.034. PMid:16690242.

9. Matsumura JS, Brewster DC, Makaroun MS, Naftel DC. A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm. J Vasc Surg. 2003;37(2):262-71. http://dx.doi.org/10.1067/mva.2003.120. PMid:12563194.

10. Alsac JM, Houbballah R, Francis F, et al. Impact of the introduction of endovascular aneurysm repair in high risk patients on our practice of elective treatment of infrarenal abdominal aortic aneurysms. Ann Vasc Surg. 2008;22(6):829-33. http://dx.doi.org/10.1016/j.avsg.2008.03.007. PMid:18804949.

11. Patel R, Sweeting MJ, Powell JT, Greenhalgh RM. EVAR trial investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366-74. http://dx.doi.org/10.1016/S0140-6736(16)31135-7. PMid:27743617.

12. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5(6):491-9. http://dx.doi.org/10.1007/BF02015271. PMid:1837729.

13. Gabrielli L, Baudo A, Molinari A, Domanin M. Early complications in endovascular treatment of abdominal aortic aneurysm. Acta Chir Belg. 2004;104(5):519-26. http://dx.doi.org/10.1080/000154 58.2004.11679608. PMid:15571017.

14. Moulakakis KG, Dalainas I, Mylonas S, Giannakopoulos TG, Avgerinos ED, Liapis CD. Conversion to open repair after endografting for abdominal aortic aneurysm: a review of causes, incidence, results, and surgical techniques of reconstruction. J Endovasc Ther. 2010;17(6):694-702. http://dx.doi.org/10.1583/1545-1550-17.6.694. PMid:21142475.

15. Hoornweg LL, Storm-Versloot MN, Ubbink DT, Koelemay MJ, Legemate DA, Balm R. Meta-analysis on mortality of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2008;35(5):558-70. http://dx.doi.org/10.1016/j.ejvs.2007.11.019. PMid:18226567.

16. Lederle FA, Johnson GR, Wilson SE, et al. Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002;287(22):2968-72. http://dx.doi.org/10.1001/jama.287.22.2968. PMid:12052126.

17. Lee WA, Carter JW, Upchurch G, Seeger JM, Huber TS. Perioperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms in the United States during 2001. J Vasc Surg. 2004;39(3):491-6. http://dx.doi.org/10.1016/j.jvs.2003.12.001. PMid:14981436.

18. Waton S, Johal A, Heikkela K, Cromwell D, Loftus I, Boyle JR. National Vascular Registry: 2017 Annual Report. London: The Royal College od Surgeons of England; 2017.

19. Becker M, Bonamigo TP, Faccini FP. Avaliação da mortalidade cirúrgica em aneurismas infra-renais da aorta abdominal. J Vasc Bras. 2002;1(1):15-21.

20. Menezes FH, Luccas CG, Matsui IA. Sobrevida tardia de pacientes submetidos à correção aberta eletiva de aneurisma de aorta abdominal. J Vasc Bras. 2007;6(3):218-24. http://dx.doi.org/10.1590/S1677-54492007000300004.

21. Carvalho AT, Santos VP, Razuk AV Fo, et al. Morbidity and mortality factors in the elective surgery of infrarenal abdominal aortic aneurysm: a case study with 134 patients. J Vasc Bras. 2008;7(3):214-24.

22. Koning GG, Vallabhneni SR, Van Marrewijk CJ, Leurs LJ, Laheij RJ, Buth J. Mortalidade relacionada ao tratamento endovascular do aneurisma da aorta abdominal com o uso dos modelos revisados. Rev Bras Cir Cardiovasc. 2007;22(1):7-13. PMid:17992299.

23. Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004;364(9437):843-8. http://dx.doi.org/10.1016/S0140-6736(04)16979-1. PMid:15351191.

24. Prinssen M, Verhoeven EL, Buth J, et al. A randomised trial comparing conventional and endovascular repair of abdominal aortic aneurysms (“DREAM”). N Engl J Med. 2004;351(16):1607-18. http://dx.doi.org/10.1056/NEJMoa042002. PMid:15483279.

25. Mendonça CT, Moreira RCR, Timi JRR, et al. Comparação entre os tratamentos aberto e endovascular dos aneurismas da aorta abdominal em pacientes de alto risco cirúrgico. J Vasc Bras. 2005;4(3):232-42. http://dx.doi.org/10.1590/S1677-54492005000300004.

26. Goshima KR, Mills JL Sr, Awari K, Pike SL, Hughes JD. Measure what matters: institutional outcome data are superior to the use of surrogate markers to define “center of excellence” for abdominal aortic aneurysm repair. Ann Vasc Surg. 2008;22(3):328-34. http://dx.doi.org/10.1016/j.avsg.2007.09.013. PMid:18411029.

27. EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005;365(9478):2187-92. http://dx.doi.org/10.1016/S0140-6736(05)66628-7. PMid:15978926.

28. Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med. 2010;362(20):1872-80. http://dx.doi.org/10.1056/NEJMoa0911056. PMid:20382982.

29. Blankensteijn JD, de Jong SE, Prinssen M, et al. Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2005;352(23):2398-405. http://dx.doi.org/10.1056/NEJMoa051255. PMid:15944424.

5cd194b60e8825d43b632f90 jvb Articles

J Vasc Bras

Share this page
Page Sections