| Objective: A retrospective study was conducted on the cases of abdominal aortic aneurysm admitted to a single center to analyze and discuss the treatment status and epidemiological characteristics of abdominal aortic aneurysm in our center,and summarize the screening clues and prognostic indicators related to abdominal aortic aneurysm.Methods: The medical record number of inpatients diagnosed with abdominal aortic aneurysm from January 1,2015 to December 31,2019 in the Department of Vascular Surgery in Wuhan Union Hospital was applied for in the medical record system of our hospital.According to the diagnostic criteria of abdominal aortic aneurysm,that is,the maximum diameter of the aneurysm ≥ 30 mm or the maximum diameter of the aneurysm exceeding 50%of the adjacent normal aortic diameter,the patient with the final definitive diagnosis of abdominal aortic aneurysm was determined based on the patients’ records and imaging examination results.Demographic information,laboratory examination,imaging examination and treatment status of the included cases were summarized.The parameters obtained were descriptive studied according to the epidemiological characteristics such as population,age distribution,aneurysm diameter distribution,whether aneurysm was operated or not,and aneurysm morphology.To analyze the epidemiological characteristics of abdominal aortic aneurysm cases admitted to our center.Results: A total of 423 patients were diagnosed and treated with abdominal aortic aneurysm,of which 372 patients finally met the requirements and could be included in the study.The number of cases showed an increasing trend every year.There were 309 males(83.1%)and 63 females(16.9%),aged(69.2 ± 9.2)years old(range: 28-93 years old)and abdominal aortic aneurysms were(48.3 ± 15.5)mm in diameter(range: 23.6-100.7 mm).Male patients were(69.3 ± 9.2)years old(range: 28-93 years old)and had an abdominal aortic aneurysm with a diameter of(48.3 ± 15.2)mm(range: 23.6-100.7 mm).The female patients were(68.6 ± 9.4)years old(range: 28-90 years old)and had an abdominal aortic aneurysm with a diameter of(48.2 ± 15.4)mm(range: 25.1-97.0 mm).In this study,patients over the age of 65 years old were the main group,up to 67.2%.The maximum diameter of abdominal aortic aneurysm was greater than 40 mm in most patients(65.9%).Of all patients,299 received endovascular treatment related to abdominal aortic aneurysm,of which 74.9%(224/299)were treated with endovascular aortic repair alone.Among the enrolled cases,symptomatic abdominal aortic aneurysm was found in 154 patients(41.4%),and hypertension(61.0%)was the main comorbidity.And 47.3% of the patients had a history of smoking,even 36.3% of the patients were still smoking at admission.During hospitalization,6 patients died,with a mortality rate of 1.6%,mainly due to aneurysm rupture.Follow-up time was(1095.7 ± 558.6)days(range: 41-2231 days),17 patients were lost to follow-up and 44 died,with a mortality rate of 12.0%.The main causes of death were malignant rumor,aneurysm rupture and cardiovascular and cerebrovascular accidents.Conclusions: In China,people over 65 years old,smoking or complicated with hypertension are the main body of AAA screening,especially when combined with abdominal pain,the screening of AAA needs to be enhanced.Patients’ age and aneurysm diameter are factors that increase the risk of rupture,and timely EVAR treatment can reduce the risk of AAA rupture.Patients’ age and COPD were the main risk factors for prognosis.Rigorous follow-up strategies and timely treatment are key to reducing AAA related deaths.Objective: To investigate the safety and efficacy of EVAR in the treatment of abdominal aortic aneurysm with hostile neck.Methods: Medical records of patients with abdominal aortic aneurysm from January1,2015 to December 31,2019 in the Department of Vascular Surgery of Wuhan Union Hospital were retrospectively analyzed.According to the diagnostic criteria of abdominal aortic aneurysm,that is,the maximum diameter of the aneurysm was greater than 30 mm or the maximum diameter of the aneurysm was greater than 50% of the adjacent normal aortic diameter,and the patients with both preoperative total/abdominal aortic CTA and underwent EVAR were identified as the final cases to be included in this study.The hostile neck was defined as neck length<15mm,neck diameter>28mm,significant neck calcification or thrombosis(>50% aortic circumference)and neck angle>60°.The efficacy and safety of endovascular aortic repair in 111 AAA patients with hostile neck and 148 AAA patients with normal neck were compared with death,EVAR-related complications and reintervention as endpoints.Results: A total of 259 patients were enrolled in this study,85.7% of whom were male.The mean age was(69.0 ± 9.6)years old(range: 28-93 years old),and most patients were older than 65 years old.There were no significant differences in demographic characteristics,comorbidities and laboratory tests between the two groups.The diameter,length and angle of proximal neck in BN group were significantly different from those in GN group.There was a significant difference in the maximum aneurysm diameter in the two groups(BN vs GN,53.4 ± 14.7mm vs 43.4 ± 11.9mm,P = 0.022).The technical success rate of BN group was 96.4%,and 4 patients developed type I endoleak.Two patients had type Ic endoleak in GN group and the technical success rate was 98.6%,with no statistically significant difference between these two groups(P=0.407).The operation time was shorter(117.5 ±63.8min vs 99.2 ± 51.1min,P = 0.011)in GN group.There was no death or intraoperation switch to open repair in both groups.There was no significant difference in the clinical success rate between the two groups(P = 0.228),and no aneurysm rupture and death occurred.The average follow-up time was(1056.1 ± 535.5)days,10 patients were lost to follow-up,and 27 patients died.The overall mortality rate was 10.4%,mainly due to aneurysm rupture,malignant tumor and cardiovascular and cerebrovascular accident.There were no significant differences in mid-term clinical success or Kaplan-Meier survival analysis between the two groups.Conclusion: Endovascular aortic repair was feasible and safe in patients of abdominal aortic aneurysm with proximal hostile neck.Early and mid-term results were satisfactory and further studies are needed to verify the long-term effectiveness. |
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