OBJECTIVETo compare mid-term results of surgical treatment with aortoiliac stenting (AIS) in patients with chronic aortoiliac occlusion.

METHODSA retrospective review of 68 patients treated between January 2005 and December 2010 was performed. Thirty-three patients underwent surgical revascularization (surgical group) and 35 patients underwent AIS (AIS group). Preoperative clinical factors and outcome data including complications, ankle-brachial index and mortality were collected. Kaplan-Meier estimates for survival, limb salvage and patency were analyzed.

RESULTSPreoperative risk factors were similar between the two groups. Surgical group were younger than AIS group ((56±11) years vs. (65±10) years, t=-2.789, P=0.008) with more patients manifesting rest pain (23/33 vs.15/35, χ2=4.963, P=0.026) and relative higher perioperative mortality (3/33 vs. 0/35, P=0.109). Mean ankle-brachial index increased significantly in both groups after operation (Surgical group 0.90±0.15 vs. 0.43±0.20, t=-7.849, P=0.000; AIS group 0.85±0.20 vs. 0.41±0.25, t=-5.379, P=0.000). Postoperative complications occurred, with statistically higher rates of respiratory failure, transient renal dysfunction and multiple organ dysfunction syndrome in surgical group (χ2=6.98, P=0.010; χ2=9.62, P=0.000; P=0.023). The 5-year primary patency in surgical group was 90.2%, compared with 64.2% in AIS group (χ2=3.717, P=0.054). No difference was observed in survival rate, limb salvage and secondary patency between the two groups.

CONCLUSIONSFive-year primary patency of endovascular reconstruction for chronic aortoiliac occlusion is lower than that for traditional open surgery. Open surgery is still the first choice for the patients who can endure the surgery. Endovascular treatment is an option for patients with high risk. However, additional interventional treatment is needed in some cases.

Adult ; Aged ; Arterial Occlusive Diseases ; surgery ; Humans ; Limb Salvage ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stents ; Survival Rate ; Treatment Outcome ; Vascular Patency ; Vascular Surgical Procedures

BACKGROUNDAlthough it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA) obtain the greatest benefit from endovascular repair (EVAR), convincing evidence on the medium-long term effect is lacking. The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR).

METHODSA search of publicly published literature was performed. Based on an inclusion and exclusion criteria, a systematic meta-analysis was undertaken to compare patient characteristics, complications, short term mortality and medium-long term outcomes. A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences. A quantitative method was used to analyze the differences between these two methods.

RESULTSA search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study. Furthermore, 13 Chinese studies were included, including 267 patients with rAAA totally, among which 238 patients received operation. The endovascular method was associated with more respiratory diseases before treatment (OR = 1.81, P = 0.01), while there are more patients with hemodynamic instability before treatment in OSR group (OR = 1.53, P = 0.031). Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml, P = 0.014). The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days, P < 0.001) and a shorter total postoperative stay (WMD 6.27 days, P < 0.001). The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR = 0.48, P < 0.001 and OR = 0.28, P = 0.043, respectively). The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR, and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70, P < 0.001). There was not, however, any significant reduction in the medium-long all-cause mortality rate (HR = 1.13, P = 0.381) and re-intervention rate (OR = 2.19, P = 0.243) following EVAR. In EVAR group, nevertheless, incidence of type I endoleak was significantly lower than type II endoleak (OR = 0.33, P = 0.039) at late follow-up period.

CONCLUSIONSOn the basis of this systematic review, rAAA EVAR results in less blood use for transfusion, shorter operation time, shorter intensive care unit and hospital stays, and lower 30-day mortality. However, in the medium-long term, it is not associated with a reduction in all-cause mortality.

Aortic Aneurysm, Abdominal ; surgery ; Aortic Rupture ; surgery ; Female ; Humans ; Male ; Postoperative Complications ; Treatment Outcome ; Vascular Surgical Procedures ; adverse effects ; methods