Cirurgia/Anestesia Não há diferença significativa entre reparo endovascular e reparo a céu aberto de aneurisma aórtico abdominal após o primeiro ano pós-operatório

02/07/2005

Pesquisadores publicaram, recentemente, no New England Journal of Medicine, um estudo em que investigaram se a melhor evolução é mantida após o período perioperatório em pacientes portadores de aneurisma aórtico abdominal submetidos à correção endovascular, comparada à correção convencional a céu aberto.   Foi realizado um ensaio clínico multicêntrico, aleatorizado, que procurou comparar a correção a céu aberto à correção por via endovascular em 351 pacientes portadores de aneurisma aórtico abdominal de diâmetro igual ou superior a 5cm, considerados elegíveis para ambas as modalidades de correção cirúrgica. A sobrevida após a aleatorização foi calculada com o uso da análise de Kaplan-Meier e comparada com o uso de log-rank test ou de acordo com a intenção-para-tratar.   Dois anos após a aleatorização, as taxas cumulativas de sobrevida foram iguais a 89,6% para correção a céu aberto e 89,7% para correção endovascular (diferença = -0,1%; IC95% = -6,8 a 6,7%). As taxas cumulativas de morte relacionada ao aneurisma foram iguais a 5,7% para correção a céu aberto e 2,1% para correção endovascular (diferença = 3,7%; IC95% = -0,5 a 7,9%). Esta melhor evolução da correção endovascular em relação à correção a céu aberto foi inteiramente responsável por eventos ocorridos no período perioperatório, sem diferença significante da mortalidade subseqüente relacionada ao aneurisma. A taxa de sobrevida livre de complicações moderadas ou graves também foi semelhante nos dois grupos após dois anos (65,9% para correção a céu aberto e 65,6% para correção endovascular; diferença = 0,3%; IC95% = -10,0 a 10,6%).   Portanto, os pesquisadores concluíram que a melhor sobrevida perioperatória após reparo endovascular de aneurisma aórtico abdominal, comparada a reparo a céu aberto, não é mantida após o primeiro ano pós-operatório. Two-Year Outcomes after Conventional or Endovascular Repair of Abdominal Aortic Aneurysms - New England Journal of Medicine 2005; 352 HOME   |   SEARCH   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   HELP Please sign in for full text and personal services   Previous Volume 352:2398-2405 June 9, 2005 Number 23 Next Two-Year Outcomes after Conventional or Endovascular Repair of Abdominal Aortic Aneurysms Jan D. Blankensteijn, M.D., Sjors E.C.A. de Jong, M.D., Monique Prinssen, M.D., Arie C. van der Ham, M.D., Jaap Buth, M.D., Steven M.M. van Sterkenburg, M.D., Hence J.M. Verhagen, M.D., Erik Buskens, M.D., Diederick E. Grobbee, M.D., for the Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group   Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Lederle, F. A. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Find Similar Articles PubMed Citation

Background Two randomized trials have shown better outcomes with elective endovascular repair of abdominal aortic aneurysms than with conventional open repair in the first month after the procedure. We investigated whether this advantage is sustained beyond the perioperative period.

Methods We conducted a multicenter, randomized trial comparing open repair with endovascular repair in 351 patients who had received a diagnosis of abdominal aortic aneurysm of at least 5 cm in diameter and who were considered suitable candidates for both techniques. Survival after randomization was calculated with the use of Kaplan–Meier analysis and compared with the use of the log-rank test on an intention-to-treat-basis.

Results Two years after randomization, the cumulative survival rates were 89.6 percent for open repair and 89.7 percent for endovascular repair (difference, –0.1 percentage point; 95 percent confidence interval, –6.8 to 6.7 percentage points). The cumulative rates of aneurysm-related death were 5.7 percent for open repair and 2.1 percent for endovascular repair (difference, 3.7 percentage points; 95 percent confidence interval, –0.5 to 7.9 percentage points). This advantage of endovascular repair over open repair was entirely accounted for by events occurring in the perioperative period, with no significant difference in subsequent aneurysm-related mortality. The rate of survival free of moderate or severe complications was also similar in the two groups at two years (at 65.9 percent for open repair and 65.6 percent for endovascular repair; difference, 0.3 percentage point; 95 percent confidence interval, –10.0 to 10.6 percentage points).

Conclusions The perioperative survival advantage with endovascular repair as compared with open repair is not sustained after the first postoperative year.

Source Information

From the Department of Vascular Surgery, Radboud University Nijmegen Medical Center, Nijmegen (J.D.B., S.E.C.A.J.); the Division of Vascular Surgery, Department of Surgery (M.P., H.J.M.V.), and the Julius Center for Health Sciences and Primary Care (S.E.C.A.J., E.B., D.E.G.), University Medical Center, Utrecht; the Department of Surgery, St. Franciscus Gasthuis, Rotterdam (A.C.H.); the Department of Surgery, Catharina Hospital, Eindhoven (J.B.); and the Department of Surgery, Rijnstate Hospital, Arnhem (S.M.M.S.) — all in the Netherlands.

Address reprint requests to Dr. Blankensteijn at the Department of Vascular Surgery (410), Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands, or at j.blankensteijn@chir.umcn.nl .