CORREÇÃO ENDOVASCULAR DE ANEURISMAS DA AORTA ABDOMINAL ROTOS E ELETIVOS: DEVEMOS ESPERAR MAIS COMPLICAÇÕES APÓS R-EVAR?
DOI:
https://doi.org/10.48750/acv.63Palavras-chave:
Aneurisma roto da Aorta Abdominal, Correção Endovascular de Aneurisma, ResultadosResumo
Introdução: O tratamento Endovascular do Aneurisma da Aorta Abdominal em rotura (r-EVAR) tem sido progressivamente adotado devido aos benefícios no curto prazo. A sobrevida após alta hospitalar parece semelhante entre r-EVAR e doentes operados eletivamente (el-EVAR). Ainda assim, devido à maior complexidade anatómica é expectável um maior risco de complicações relacionadas com o aneurisma após r-EVAR.
Métodos: Bases de dados MEDLINE foram pesquisadas no sentido de identificar publicações reportando outcomes após r-EVAR e el-EVAR. Ensaios clínicos randomizados foram usados para comparação.
Resultado: Após a alta outcomes (except mortalidade), foram reportados em 5 estudos incluindo 509 pacientes r-EVAR. Comparação direta entre r-EVAR e el-EVAR foi encontrada em dois estudos incluindo 2895 doentes (256 r-EVAR and 2653 el-EVAR). Taxas de endoleak tipo I variaram entre 5.4-21% para o grupo r-EVAR e entre 4.4-10% no grupo el-EVAR. Taxas de rintervenções no grupo r-EVAR variaram entre 16.7-76% e entre 11-27.7% no grupo i-EVAR. Taxa de complicações aos 5 anos após r-EVAR dentro das instructions for use (IFU) foi de 8.8% e reiintervenções de 16.7%.
Conclusão: Pacientes r-EVAR apresentam taxas mais altas de endoleaks tipo I e ntervenções secundárias. Contudo, quando dentro das IFU, as taxas de complicações relacionadas com o aneurisma são sobreponíveis ao el-EVAR. Estratégias de follow-up devem ser ajustadas de acordo com a anatomia basal e complicações precoces e não de acordo com timing de reparação.
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Referências
1. Katzen BT, Dake MD, MacLean AA, Wang DS. Endovascular
repair of abdominal and thoracic aortic aneurysms. Circulation
2005;112:1663-75.
2. Reimerink JJ, van der Laan MJ, Koelemay MJ, Balm R, Legemate
DA. Systematic review and meta-analysis of population-based
mortality from ruptured abdominal aortic aneurysm. The British
journal of surgery 2013;100:1405-13.
3. 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
(London, England) 2004;364:843-8.
4. Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following
endovascular vs open repair of abdominal aortic aneurysm:
a randomized trial. Jama 2009;302:1535-42.
5. Sousa J, Brandao D, Barreto P, Ferreira J, Almeida Lopes J, Mansilha
A. [Percutaneous Endovascular Aortic Repair with Local Anesthesia
- One Day Surgery]. Acta medica portuguesa 2016;29:381-8.
6. Mayer D, Aeschbacher S, Pfammatter T, et al. Complete replacement
of open repair for ruptured abdominal aortic aneurysms by
endovascular aneurysm repair: a two-center 14-year experience.
Annals of surgery 2012;256:688-95; discussion 95-6.
7. Veith FJ, Lachat M, Mayer D, et al. Collected world and single center
experience with endovascular treatment of ruptured abdominal
aortic aneurysms. Annals of surgery 2009;250:818-24.
8. Mani K, Bjorck M, Lundkvist J, Wanhainen A. Improved long-term
survival after abdominal aortic aneurysm repair. Circulation
2009;120:201-11.
9. Bastos Goncalves F, Ultee KH, Hoeks SE, Stolker RJ, Verhagen
HJ. Life expectancy and causes of death after repair of intact
and ruptured abdominal aortic aneurysms. Journal of vascular
surgery 2016;63:610-6.
10. Slater BJ, Harris EJ, Lee JT. Anatomic suitability of ruptured abdominal
aortic aneurysms for endovascular repair. Annals of vascular
surgery 2008;22:716-22.
11. Hinchliffe RJ, Alric P, Rose D, et al. Comparison of morphologic
features of intact and ruptured aneurysms of infrarenal abdominal
aorta. Journal of vascular surgery 2003;38:88-92.
12. Reimerink JJ, Hoornweg LL, Vahl AC, et al. Endovascular repair
versus open repair of ruptured abdominal aortic aneurysms:
a multicenter randomized controlled trial. Annals of surgery
2013;258:248-56.
13. Desgranges P, Kobeiter H, Katsahian S, et al. Editor's Choice
- ECAR (Endovasculaire ou Chirurgie dans les Anevrysmes
aorto-iliaques Rompus): A French Randomized Controlled Trial
of Endovascular Versus Open Surgical Repair of Ruptured Aorto-
-iliac Aneurysms. European journal of vascular and endovascular
surgery : the official journal of the European Society for Vascular
Surgery 2015;50:303-10.
14. Powell JT, Sweeting MJ, Thompson MM, et al. Endovascular or
open repair strategy for ruptured abdominal aortic aneurysm:
30 day outcomes from IMPROVE randomised trial. BMJ (Clinical
research ed) 2014;348:f7661.
15. Endovascular strategy or open repair for ruptured abdominal
aortic aneurysm: one-year outcomes from the IMPROVE randomized
trial. European heart journal 2015;36:2061-9.
16. Powell JT, MD, IMPROVE Trial Investigators. Imperial College
London, London, United Kingdom. Three-Year Outcomes of the
IMPROVE Trial for Ruptured Abdominal Aortic Aneurysm. Journal
of vascular surgery 2017;June Supplement 2017.
17. Sterpetti AV, Cavallaro A, Cavallari N, et al. Factors influencing the
rupture of abdominal aortic aneurysms. Surgery, gynecology &
obstetrics 1991;173:175-8.
18. Brown LC, Powell JT. Risk factors for aneurysm rupture in patients
kept under ultrasound surveillance. UK Small Aneurysm Trial Participants.
Annals of surgery 1999;230:289-96; discussion 96-7.
19. Sweeting MJ, Thompson SG, Brown LC, Powell JT. Meta-analysis of
individual patient data to examine factors affecting growth and
rupture of small abdominal aortic aneurysms. The British journal
of surgery 2012;99:655-65.
20. Lederle FA, Johnson GR, Wilson SE. Abdominal aortic aneurysm in
women. Journal of vascular surgery 2001;34:122-6.
21. Baderkhan H, Goncalves FM, Oliveira NG, et al. Challenging
Anatomy Predicts Mortality and Complications After Endovascular
Treatment of Ruptured Abdominal Aortic Aneurysm. Journal
of endovascular therapy : an official journal of the International
Society of Endovascular Specialists 2016;23:919-27.
22. Noorani A, Page A, Walsh SR, Varty K, Hayes PD, Boyle JR. Mid-term
outcomes following emergency endovascular aortic aneurysm
repair for ruptured abdominal aortic aneurysms. European journal
of vascular and endovascular surgery : the official journal of
the European Society for Vascular Surgery 2012;43:382-5.
23. Quinn AA, Mehta M, Teymouri MJ, et al. The incidence and fate of
endoleaks vary between ruptured and elective endovascular
abdominal aortic aneurysm repair. Journal of vascular surgery 2017.
24. Broos PP, t Mannetje YW, Stokmans RA, et al. A 15-Year Single-
-Center Experience of Endovascular Repair for Elective and
Ruptured Abdominal Aortic Aneurysms. Journal of endovascular
therapy : an official journal of the International Society of Endovascular
Specialists 2016;23:566-73.
25. Roos H, Djerf H, Brisby Jeppsson L, et al. Re-interventions after endovascular
aortic repair for infrarenal abdominal aneurysms: a retrospective
cohort study. BMC cardiovascular disorders 2016;16:124.
26. van Beek SC, Vahl A, Wisselink W, Reekers JA, Legemate DA, Balm
R. Midterm Re-interventions and Survival After Endovascular
Versus Open Repair for Ruptured Abdominal Aortic Aneurysm.
European journal of vascular and endovascular surgery : the
official journal of the European Society for Vascular Surgery
2015;49:661-8.
27. Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D,
Sculpher MJ. Endovascular versus open repair of abdominal aortic
aneurysm. The New England journal of medicine 2010;362:1863-71.
28. De Bruin JL, Baas AF, Buth J, et al. Long-term outcome of open
or endovascular repair of abdominal aortic aneurysm. The New
England journal of medicine 2010;362:1881-9.
29. Lederle FA, Freischlag JA, Kyriakides TC, et al. Long-term comparison
of endovascular and open repair of abdominal aortic aneurysm.
The New England journal of medicine 2012;367:1988-97.
30. Becquemin JP, Pillet JC, Lescalie F, et al. A randomized controlled
trial of endovascular aneurysm repair versus open surgery for
abdominal aortic aneurysms in low- to moderate-risk patients.
Journal of vascular surgery 2011;53:1167-73 e1.
31. Lesperance K, Andersen C, Singh N, Starnes B, Martin MJ. Expanding
use of emergency endovascular repair for ruptured abdominal
aortic aneurysms: disparities in outcomes from a nationwide
perspective. Journal of vascular surgery 2008;47:1165-70;
discussion 70-1.
32. Moore R, Nutley M, Cina CS, Motamedi M, Faris P, Abuznadah W.
Improved survival after introduction of an emergency endovascular
therapy protocol for ruptured abdominal aortic aneurysms.
Journal of vascular surgery 2007;45:443-50.
33. Gupta PK, Ramanan B, Engelbert TL, Tefera G, Hoch JR, Kent KC. A
comparison of open surgery versus endovascular repair of unstable
ruptured abdominal aortic aneurysms. Journal of vascular
surgery 2014;60:1439-45.
34. Anain PM, Anain JM, Sr., Tiso M, Nader ND, Dosluoglu HH. Early
and mid-term results of ruptured abdominal aortic aneurysms in
the endovascular era in a community hospital. Journal of vascular
surgery 2007;46:898-905.
35. Starnes BW, Quiroga E, Hutter C, et al. Management of ruptured
abdominal aortic aneurysm in the endovascular era. Journal of
vascular surgery 2010;51:9-17; discussion -8.
36. Endovascular aneurysm repair versus open repair in patients with
abdominal aortic aneurysm (EVAR trial 1): randomised controlled
trial. Lancet (London, England) 2005;365:2179-86.
37. Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing
conventional and endovascular repair of abdominal aortic aneurysms.
The New England journal of medicine 2004;351:1607-18.
38. Lederle FA. Abdominal aortic aneurysm--open versus endovascular
repair. The New England journal of medicine 2004;351:1677-9.
39. Bastos Goncalves F, Baderkhan H, Verhagen HJ, et al. Early sac
shrinkage predicts a low risk of late complications after endovascular
aortic aneurysm repair. The British journal of surgery
2014;101:802-10.
40. t Mannetje YW, Cuypers PW, Saleem BR, Bode AS, Teijink JA, van
Sambeek MR. Comparison of midterm results for the Talent and
Endurant stent graft. Journal of vascular surgery 2017.
41. Singh MJ, Fairman R, Anain P, et al. Final results of the Endurant
Stent Graft System in the United States regulatory trial. Journal
of vascular surgery 2016;64:55-62.
42. Greenberg RK, Chuter TA, Cambria RP, Sternbergh WC, 3rd, Fearnot
NE. Zenith abdominal aortic aneurysm endovascular graft.
Journal of vascular surgery 2008;48:1-9.
repair of abdominal and thoracic aortic aneurysms. Circulation
2005;112:1663-75.
2. Reimerink JJ, van der Laan MJ, Koelemay MJ, Balm R, Legemate
DA. Systematic review and meta-analysis of population-based
mortality from ruptured abdominal aortic aneurysm. The British
journal of surgery 2013;100:1405-13.
3. 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
(London, England) 2004;364:843-8.
4. Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following
endovascular vs open repair of abdominal aortic aneurysm:
a randomized trial. Jama 2009;302:1535-42.
5. Sousa J, Brandao D, Barreto P, Ferreira J, Almeida Lopes J, Mansilha
A. [Percutaneous Endovascular Aortic Repair with Local Anesthesia
- One Day Surgery]. Acta medica portuguesa 2016;29:381-8.
6. Mayer D, Aeschbacher S, Pfammatter T, et al. Complete replacement
of open repair for ruptured abdominal aortic aneurysms by
endovascular aneurysm repair: a two-center 14-year experience.
Annals of surgery 2012;256:688-95; discussion 95-6.
7. Veith FJ, Lachat M, Mayer D, et al. Collected world and single center
experience with endovascular treatment of ruptured abdominal
aortic aneurysms. Annals of surgery 2009;250:818-24.
8. Mani K, Bjorck M, Lundkvist J, Wanhainen A. Improved long-term
survival after abdominal aortic aneurysm repair. Circulation
2009;120:201-11.
9. Bastos Goncalves F, Ultee KH, Hoeks SE, Stolker RJ, Verhagen
HJ. Life expectancy and causes of death after repair of intact
and ruptured abdominal aortic aneurysms. Journal of vascular
surgery 2016;63:610-6.
10. Slater BJ, Harris EJ, Lee JT. Anatomic suitability of ruptured abdominal
aortic aneurysms for endovascular repair. Annals of vascular
surgery 2008;22:716-22.
11. Hinchliffe RJ, Alric P, Rose D, et al. Comparison of morphologic
features of intact and ruptured aneurysms of infrarenal abdominal
aorta. Journal of vascular surgery 2003;38:88-92.
12. Reimerink JJ, Hoornweg LL, Vahl AC, et al. Endovascular repair
versus open repair of ruptured abdominal aortic aneurysms:
a multicenter randomized controlled trial. Annals of surgery
2013;258:248-56.
13. Desgranges P, Kobeiter H, Katsahian S, et al. Editor's Choice
- ECAR (Endovasculaire ou Chirurgie dans les Anevrysmes
aorto-iliaques Rompus): A French Randomized Controlled Trial
of Endovascular Versus Open Surgical Repair of Ruptured Aorto-
-iliac Aneurysms. European journal of vascular and endovascular
surgery : the official journal of the European Society for Vascular
Surgery 2015;50:303-10.
14. Powell JT, Sweeting MJ, Thompson MM, et al. Endovascular or
open repair strategy for ruptured abdominal aortic aneurysm:
30 day outcomes from IMPROVE randomised trial. BMJ (Clinical
research ed) 2014;348:f7661.
15. Endovascular strategy or open repair for ruptured abdominal
aortic aneurysm: one-year outcomes from the IMPROVE randomized
trial. European heart journal 2015;36:2061-9.
16. Powell JT, MD, IMPROVE Trial Investigators. Imperial College
London, London, United Kingdom. Three-Year Outcomes of the
IMPROVE Trial for Ruptured Abdominal Aortic Aneurysm. Journal
of vascular surgery 2017;June Supplement 2017.
17. Sterpetti AV, Cavallaro A, Cavallari N, et al. Factors influencing the
rupture of abdominal aortic aneurysms. Surgery, gynecology &
obstetrics 1991;173:175-8.
18. Brown LC, Powell JT. Risk factors for aneurysm rupture in patients
kept under ultrasound surveillance. UK Small Aneurysm Trial Participants.
Annals of surgery 1999;230:289-96; discussion 96-7.
19. Sweeting MJ, Thompson SG, Brown LC, Powell JT. Meta-analysis of
individual patient data to examine factors affecting growth and
rupture of small abdominal aortic aneurysms. The British journal
of surgery 2012;99:655-65.
20. Lederle FA, Johnson GR, Wilson SE. Abdominal aortic aneurysm in
women. Journal of vascular surgery 2001;34:122-6.
21. Baderkhan H, Goncalves FM, Oliveira NG, et al. Challenging
Anatomy Predicts Mortality and Complications After Endovascular
Treatment of Ruptured Abdominal Aortic Aneurysm. Journal
of endovascular therapy : an official journal of the International
Society of Endovascular Specialists 2016;23:919-27.
22. Noorani A, Page A, Walsh SR, Varty K, Hayes PD, Boyle JR. Mid-term
outcomes following emergency endovascular aortic aneurysm
repair for ruptured abdominal aortic aneurysms. European journal
of vascular and endovascular surgery : the official journal of
the European Society for Vascular Surgery 2012;43:382-5.
23. Quinn AA, Mehta M, Teymouri MJ, et al. The incidence and fate of
endoleaks vary between ruptured and elective endovascular
abdominal aortic aneurysm repair. Journal of vascular surgery 2017.
24. Broos PP, t Mannetje YW, Stokmans RA, et al. A 15-Year Single-
-Center Experience of Endovascular Repair for Elective and
Ruptured Abdominal Aortic Aneurysms. Journal of endovascular
therapy : an official journal of the International Society of Endovascular
Specialists 2016;23:566-73.
25. Roos H, Djerf H, Brisby Jeppsson L, et al. Re-interventions after endovascular
aortic repair for infrarenal abdominal aneurysms: a retrospective
cohort study. BMC cardiovascular disorders 2016;16:124.
26. van Beek SC, Vahl A, Wisselink W, Reekers JA, Legemate DA, Balm
R. Midterm Re-interventions and Survival After Endovascular
Versus Open Repair for Ruptured Abdominal Aortic Aneurysm.
European journal of vascular and endovascular surgery : the
official journal of the European Society for Vascular Surgery
2015;49:661-8.
27. Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D,
Sculpher MJ. Endovascular versus open repair of abdominal aortic
aneurysm. The New England journal of medicine 2010;362:1863-71.
28. De Bruin JL, Baas AF, Buth J, et al. Long-term outcome of open
or endovascular repair of abdominal aortic aneurysm. The New
England journal of medicine 2010;362:1881-9.
29. Lederle FA, Freischlag JA, Kyriakides TC, et al. Long-term comparison
of endovascular and open repair of abdominal aortic aneurysm.
The New England journal of medicine 2012;367:1988-97.
30. Becquemin JP, Pillet JC, Lescalie F, et al. A randomized controlled
trial of endovascular aneurysm repair versus open surgery for
abdominal aortic aneurysms in low- to moderate-risk patients.
Journal of vascular surgery 2011;53:1167-73 e1.
31. Lesperance K, Andersen C, Singh N, Starnes B, Martin MJ. Expanding
use of emergency endovascular repair for ruptured abdominal
aortic aneurysms: disparities in outcomes from a nationwide
perspective. Journal of vascular surgery 2008;47:1165-70;
discussion 70-1.
32. Moore R, Nutley M, Cina CS, Motamedi M, Faris P, Abuznadah W.
Improved survival after introduction of an emergency endovascular
therapy protocol for ruptured abdominal aortic aneurysms.
Journal of vascular surgery 2007;45:443-50.
33. Gupta PK, Ramanan B, Engelbert TL, Tefera G, Hoch JR, Kent KC. A
comparison of open surgery versus endovascular repair of unstable
ruptured abdominal aortic aneurysms. Journal of vascular
surgery 2014;60:1439-45.
34. Anain PM, Anain JM, Sr., Tiso M, Nader ND, Dosluoglu HH. Early
and mid-term results of ruptured abdominal aortic aneurysms in
the endovascular era in a community hospital. Journal of vascular
surgery 2007;46:898-905.
35. Starnes BW, Quiroga E, Hutter C, et al. Management of ruptured
abdominal aortic aneurysm in the endovascular era. Journal of
vascular surgery 2010;51:9-17; discussion -8.
36. Endovascular aneurysm repair versus open repair in patients with
abdominal aortic aneurysm (EVAR trial 1): randomised controlled
trial. Lancet (London, England) 2005;365:2179-86.
37. Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing
conventional and endovascular repair of abdominal aortic aneurysms.
The New England journal of medicine 2004;351:1607-18.
38. Lederle FA. Abdominal aortic aneurysm--open versus endovascular
repair. The New England journal of medicine 2004;351:1677-9.
39. Bastos Goncalves F, Baderkhan H, Verhagen HJ, et al. Early sac
shrinkage predicts a low risk of late complications after endovascular
aortic aneurysm repair. The British journal of surgery
2014;101:802-10.
40. t Mannetje YW, Cuypers PW, Saleem BR, Bode AS, Teijink JA, van
Sambeek MR. Comparison of midterm results for the Talent and
Endurant stent graft. Journal of vascular surgery 2017.
41. Singh MJ, Fairman R, Anain P, et al. Final results of the Endurant
Stent Graft System in the United States regulatory trial. Journal
of vascular surgery 2016;64:55-62.
42. Greenberg RK, Chuter TA, Cambria RP, Sternbergh WC, 3rd, Fearnot
NE. Zenith abdominal aortic aneurysm endovascular graft.
Journal of vascular surgery 2008;48:1-9.
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Publicado
2018-12-02
Como Citar
1.
Oliveira Pinto J, Sousa J, Neves JR, Leite-Moreira A, Mansilha A. CORREÇÃO ENDOVASCULAR DE ANEURISMAS DA AORTA ABDOMINAL ROTOS E ELETIVOS: DEVEMOS ESPERAR MAIS COMPLICAÇÕES APÓS R-EVAR?. Angiol Cir Vasc [Internet]. 2 de Dezembro de 2018 [citado 24 de Novembro de 2024];14(1):47-52. Disponível em: https://acvjournal.com/index.php/acv/article/view/63
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