Arteria iliaca aneurysma nyitott és endovascularis kezelése = Open and endovascular repair of iliac artery aneurysms (2018)

Absztrakt: Bevezetes es celkitűzes: Az arteria iliaca aneurysmak az osszes
 aneurysmak 2%-at teszik ki. Optimalis kezelesuk nem egyertelmű, sebeszi
 kezelesuk eredmenyeiről alig all rendelkezesre hazai adat. Celkitűzesunk volt az
 arteria iliaca aneurysma miatt operalt betegek mortalitasanak es perioperativ
 morbiditasanak elemzese, valamint az elektiv nyitott műteten es
 stentgraft-implantacion (EVIAR) atesett betegcsoportok eredmenyeinek
 osszehasonlitasa. Modszer: Egy intezmenyben 2005. januar 1. es
 2014. december 31. kozott arteria iliaca aneurysma miatt műteten atesett betegek
 retrospektiv vizsgalata. Eredmenyek: Tiz ev alatt 62 betegnel
 vegeztunk elektiv műtetet arteria iliaca aneurysma miatt (54 ferfi [87,1%]). A
 betegek atlageletkora 68,9 ev (19–89 ev) volt. Tiz esetben vegeztunk akut
 műtetet aneurysma ruptura miatt (13,9%), ezek kozul 3 beteg halt meg a
 perioperativ időszakban (30%). Az anatomiai lokalizaciot tekintve tobbsegeben az
 arteria iliaca communison (80,6%) alakult ki ertagulat. Elektiv beavatkozaskent
 nyitott műtetet 35 esetben (56,5%), EVIAR-t 25 esetben (40,3%), egyeb
 endovascularis intervenciot 2 esetben (3,2%) vegeztunk. A posztoperativ
 szovődmeny (1 fő [4,0%] vs. 17 fő [48,5%]; p<0,001) es az intenziv osztalyos
 kezeles [29 fő (82,8%) vs. 2 fő (8,0%); p<0,001] szignifikansan ritkabb
 EVIAR-t kovetően, mint nyitott műtet eseten. Tovabba szignifikansan kevesebb a
 posztoperativ korhazi apolasi napok szama (4,7 ± 2,3 nap vs. 11,8 ± 12,2 nap; p
 = 0,006) es a transzfuzios igeny (1 fő [4,0%] vs. 26 fő [74,2%]; p<0,001)
 EVIAR vegzese soran. A hosszu tavu tulelesi arany a ket modszer kozott nem
 kulonbozott jelentős mertekben (81,4% vs. 71,4%; p = 0,95).
 Kovetkeztetes: Az arteria iliaca tagulat sebeszi
 kezelesenek szuksegessege eseten, alacsonyabb szovődmenyrataja es korhazi
 apolasigenye miatt, az endovascularis műtetet ajanljuk elsősorban. Orv Hetil.
 2018; 159(13): 520–525.
 | Abstract: Introduction and aim: Iliac artery aneurysms make up 2% of all
 aneurysms. There are only a few data available on the results of surgical
 treatment, therefore the optimal treatment is unclear. Our objective was the
 retrospective analysis of the perioperative morbidity and mortality of patients
 who underwent iliac artery surgery as well as the comparison of elective open
 surgery and endovascular iliac aneurysm repair (EVIAR). Method:
 Retrospective analysis of patients who underwent surgery for iliac artery
 aneurysm between 1 January 2005 and 31 December 2014. Results:
 During the 10-year period, 62 patients with a mean age of 68.9 years underwent
 elective surgery for iliac artery aneurysm (54 males, 87.1%). In 10 cases acute
 surgery was performed due to aneurysm ruptures (13.9%), 3 patients died within
 the perioperative period (30%). Regarding anatomical localisation, aneurysm
 developed mostly on the common iliac artery (80.6%). As an elective surgery, 35
 patients (56.5%) underwent open surgery, 25 (40.3%) underwent EVIAR and other
 endovascular interventions were performed in 2 cases (3.2%). Postoperative
 complications (1 patient [4.0%] vs. 17 patients [48.5%]; p<0.001) and
 intensive care treatment (29 patients [82.8%] vs. 2 patients [8.0%]; p<0.001)
 were significantly rarer after EVIAR than after open surgery. Furthermore, EVIAR
 resulted in considerably shorter postoperative hospital stays (4.7 ± 2.3 days
 vs. 11.8 ± 12.2 days; p = 0.006) and significantly less blood transfusion demand
 (1 patient [4.0%] vs. 26 patients [74.2%]; p<0.001). There were no
 significant differences regarding long-term survival rates between EVIAR and
 open surgery (81.4% vs. 71.4%; p = 0.95). Conclusion: In case
 of the surgical treatment of iliac artery aneurysms, owing to the lower
 complication rates and shorter postoperative length of stay, EVIAR is primarily
 recommended. Orv Hetil. 2018; 159(13): 520–525.