Abdominal aort anevrizmalarında endovasküler aort onarımının klinik sonuçları: tek merkez deneyimi

Year 2025, Volume: 6 Issue: 5, 465 - 469, 24.10.2025

Güler Gülsen Ersoy , Üzeyir Yılmaz

Abstract

Amaç: Bu çalışmada, kliniğimizde Abdominal Aort Anevrizması (AAA) nedeniyle Endovasküler Aort Anevrizma Onarımı (EVAR) uygulanan 35 hastanın erken ve orta dönem klinik sonuçlarının değerlendirilmesi amaçlanmıştır.
Yöntemler: Mayıs 2021-Mayıs 2025 tarihleri arasında hastanemizde AAA nedeniyle EVAR uygulanan toplam 35 hasta retrospektif olarak değerlendirildi. Hastaların demografik özellikleri, anevrizma morfolojisi, müdahale detayları, perioperatif komplikasyonlar, postoperatif takip süreci ve mortalite oranları analiz edildi.
Bulgular: Çalışmaya dahil edilen 35 hastanın 30'u erkek (%85,7), beşi kadındı (%14,3). Ortalama yaş 72,1±7,9 yıldı. Ortalama anevrizma çapı 6,4±1,2 cm olarak ölçüldü. Hastalardan 2'sinde erken postoperatif mortalite gözlendi. Her iki hasta da AAA rüptürü nedeniyle yatırıldı. Ameliyat sonrası erken dönemde başka bir komplikasyonla karşılaşılmadı. Tüm hastalar işlemden sonra 24 saat yoğun bakım ünitesinde takip edildi. Ortalama yoğun bakım kalış süresi 17,3 ± 4,8 saat olarak belirlenirken, hastanede kalış süresi 3,2 ± 1,1 gün arasında değişti. Hastane takip süresi boyunca 2 hastada (%5,7) erken mortalite gözlendi. İşlemden sonraki 6 aylık takipte endoleak gözlenmedi.
Sonuç: Endovasküler aort anevrizma onarımı, uygun hastalarda açık cerrahiye kıyasla daha düşük morbidite ve mortalite oranlarına sahip, güvenli ve etkili bir tedavi yöntemidir. Ancak hastaların düzenli radyolojik takibi ve komplikasyonların erken teşhisi tedavi başarısını doğrudan etkiler.

Keywords

Endovasküler aort tamiri , Abdominal Aort Anevrizması , Klinik Sonuçlar

Clinical outcomes of endovascular aortic repair in abdominal aortic aneurysms: a single-center experience

Abstract

Aims: This study aims to evaluate the early and mid-term clinical outcomes of 35 patients who underwent endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) in a tertiary peripheral hospital.
Methods: A total of 35 patients who underwent EVAR due to AAA in our hospital between May 2021 and May 2025 were evaluated retrospectively. Demographic characteristics of the patients, aneurysm morphology, intervention details, perioperative complications, postoperative follow-up process, and mortality rates were analyzed.
Results: Of the 35 patients included in the study, 30 were male (85.7%) and five were female (14.3%). The mean age was 70.8±7.9 years. The mean aneurysm diameter was measured as 63.1±10.7 mm. Early postoperative mortality was observed in 2 of the patients. Both of these patients were admitted due to ruptured AAA. No other complications were encountered in the early postoperative period. All patients were followed up in the intensive care unit for 24 hours after the procedure. The total hospital stay varied between 5±1 days. Early mortality was observed in 2 patients (5.7%) during the hospital follow-up period. No endoleak was observed in the 6-month follow-up after the procedure.
Conclusion: Endovascular aortic aneurysm repair is a safe and effective treatment method with lower morbidity and mortality rates compared to open surgery in appropriate patients. However, regular radiological follow-up of patients and early detection of complications directly affect treatment success.

Keywords

Endovascular aortic repair , abdominal aortic aneurysm , clinical outcomes

Ethical Statement

The study protocol was approved by the Non-interventional Clinical Researches Ethics Committee of Kastamonu University (Date: 14.07.2025, Decision No: 2025-07).

Supporting Institution

Kastamou Üniversitesi Tıp Fakültesi

Thanks

Prof Dr.Osman Güler. Kastamou Üniversitesi Tıp Fakültesi Dekanı.

References

• Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practices guidelines for patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.e2. doi:10.1016/j.jvs.2017.10.044
• Svensjö S, Björck M, Wanhainen A. The risk of rupture in patients with abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 2011;42(4):496-502.
• Lederle FA, Freischlag JA, Kyriakides TC, et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med. 2012;367(21):1988-1997. doi:10.1056/NEJMoa1207481
• Kent KC. Clinical practice. Abdominal aortic aneurysms. N Engl J Med. 2014;371(22):2101-2108. doi:10.1056/NEJMcp1401430
• Machado R, Teixeira G, Oliveira P, Loureiro L, Pereira C, Almeida R. Is age a determinant factor in EVAR as a predictor of outcomes or in the selection procedure? Our experience. Braz J Cardiovasc Surg. 2016;31(2): 132-139. doi:10.5935/1678-9741.20160037
• Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG; EVAR trial participants. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomized controlled trial. Lancet. 2004;364(9437):843-848. doi:10.1016/S0140-6736(04)16979-1
• Schermerhorn ML, O’Malley AJ, Jhaveri A, et al. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med. 2008;358(5):464-474. doi:10.1056/NEJMoa0707348
• Moll FL, Powell JT, Fraedrich G, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg. 2011;41(Suppl 1):S1-58. doi: 10.1016/j.ejvs.2010.09.011
• Santoro D, Benedetto F, Mondello P, et al. Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis. 2014;7: 281-294. doi:10.2147/IJNRD.S46643
• Zettervall SL, Soden PA, Cronenwett JL, et al. National trends in abdominal aortic aneurysm repair from 2000 to 2010. J Vasc Surg. 2014; 60(4):906-911.
• Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5(6): 491-499. doi:10.1007/BF02015271
• O'Donnell TFX, Holscher CM, Landon BE, et al. Proximal neck morphology and EVAR outcomes: a systematic review and meta-analysis. J Vasc Surg. 2019;70(6):2011-2020.
• White GH, Yu W, May J, Petrasek P. Endoleak as a complication of endoluminal grafting of abdominal aortic aneurysms. J Endovasc Surg. 1997;4(2):152-168. doi:10.1177/152660289700400207
• Schanzer A, Messina LM, Simons JP, et al. Risk factors associated with type I endoleak following endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2011;53(5):1234-1239.
• Egorova N, Quiroga E, Gelijns A, et al. Clinical factors related to outcome after abdominal aortic aneurysm repair. J Vasc Surg. 2010;52(1):29-41.
• Eurostar Collaborators. Endovascular aneurysm repair: radiological follow-up and late results of the EUROSTAR Registry. J Vasc Surg. 2004; 40(6):1158-1165.
• Laheij RJ, Kock MC, Heijmen RH, et al. Device-related complications after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2006; 43(1):60-65.
• Piffaretti G, Tozzi M, Rivolta N, et al. Spinal cord ischemia following endovascular thoracic aortic repair: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2017;53(4):457-465.
• Patel R, Sweeting MJ, Powell JT, Greenhalgh RM; EVAR Trial Investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-year follow-up of the UK EVAR trial 1: a randomized controlled trial. Lancet. 2016;388(10058):2366-2374. doi:10.1016/S0140-6736(16)31135-7
• Schermerhorn ML, Buck DB, O'Malley AJ, et al. Long-term outcomes of abdominal aortic aneurysm in the medicare population. N Engl J Med. 2015;373(4):328-338. doi:10.1056/NEJMoa1405778
• Van Schaik J, Heijmen RH, Prinssen M, et al. Late outcome of abdominal aortic aneurysm after endovascular repair in the EUROSTAR Registry. J Vasc Surg. 2004;40(6):1158-1165.
• Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2008;358(5):494-501. doi:10.1056/NEJMct 0707524
• Leurs LJ, Buth J, Harris PL, Blankensteijn JD. Impact of study design on outcome after endovascular abdominal aortic aneurysm repair. A comparison between the randomized controlled DREAM trial and the observational EUROSTAR registry. Eur J Vasc Endovasc Surg. 2007; 33(2):172-176. doi:10.1016/j.ejvs.2006.09.011
• Vienneau JR, Burns CI, Boghokian A, Soti V. Endovascular aneurysm repair versus open surgical repair in treating abdominal aortic aneurysm. Cureus. 2024;16(11):e73066. doi:10.7759/cureus.73066
• Li B, Khan S, Salata K, et al. A systematic review and meta-analysis of the long-term outcomes of endovascular versus open repair of abdominal aortic aneurysm. J Vasc Surg. 2019;70(3):954-969.e30. doi:10.1016/j.jvs. 2019.01.076
• Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004;351(16):1607-1618. doi:10.1056/NEJMoa042002
• Andraska EA, Phillips AR, Reitz KM, et al. Longer follow-up intervals following endovascular aortic aneurysm repair are safe and appropriate after marked aneurysm sac regression. J Vasc Surg. 2022 Aug;76(2):454-460. doi:10.1016/j.jvs.2022.01.079
• De Bruin JL, Baas AF, Buth J, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010; 362(20):1881-1889. doi:10.1056/NEJMoa0909499