Midterm Results of Endovascular Repair of Abdominal Aortic Aneurysm with Concomitant Malignancy
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Background: The management of patients with abdominal aortic aneurysm (AAA) and concurrent malignant disease is controversial, and few reports are available on the result of endovascular aortic repair (EVAR) for such challenging cases. We have routinely performed EVAR as a first line therapy for the patients of AAA complicated with malignant diseases. To confirm the validity of our management, a retrospective review of concomitant AAA and malignant disease was undertaken.Methods: A total of 159 patients who underwent EVAR for AAA from April 2007 to April 2011 were reviewed. Among these, 22 patients (13.8%) who had concomitant malignant disease were defined as the "M group", and the other 137 patients (86.2%) without malignant disease were the "N group". The mean follow-up was 15.0±2.1 months (range, 1.9 to 37.3 months) in the M group and 16.3±1.0 months (range, 0.3 to 45.4 months) in the N group. We performed a comparison of mid-term outcomes between the M and N group including mortality, aneurysm-related mortality, reintervention, development or resolution of endoleaks, and other complications.Results: Twenty-one patients expired (M: 7 patients, N: 14 patients) during this study period, and the causes of death were malignant disease in 9 patients. In the M group, 6 of 7 patients (85.7%, Stage II: 1 patient, III: 4 patients, IV: 1 patient) died because of the concurrent malignant disease. No aneurysm-related deaths occurred. In the M group, no patient died perioperatively; in the N group, one patient died perioperatively (0.7%; P=NS). Postoperative complications occurred in 4 patients in the M group and in 26 patients in the N group for a morbidity rate, respectively, of 18.1% and 19.0% (P=NS). At 1 and 3 years, survival rates were 77.4±10.2% and 50.8±14.3% in the M group and 93.7±2.3% and 72.3±9.4% in the N group (log-rank P=0.012).Conclusion: EVAR is a safe technique and could be a first line therapy for the treatment of AAA with malignant disease. However, in cases of advanced malignant disease ≥ Stage III, because the patients cannot be expected to achieve long-term survival, our indications for EVAR are limited to life-threatening conditions (rupture or impending rupture, for example).
- 特定非営利活動法人 日本血管外科学会の論文
特定非営利活動法人 日本血管外科学会 | 論文
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