confronto caso- controllo fra chirurgia open ed endovascolare · vascular and endovascular surgery...
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Vascular and Endovascular Surgery Unit- University of Florence
CONFRONTO CASO-CONTROLLO FRA CHIRURGIA OPEN ED ENDOVASCOLARE
DELL’ANEURISMA DELL’ARTERIA POPLITEA
S. SpezialiE. Giacomelli, A. Alessi Innocenti, A. Fargion,W. Dorigo, C. Lasagni, B. Giannasio, E. Chiti,
C. Pratesi
Vascular and Endovascular Surgery Unit- University of Florence
(2008)
Vascular and Endovascular Surgery Unit- University of Florence
(J Vasc Surg 2015)
Vascular and Endovascular Surgery Unit- University of Florence
Vascular and Endovascular Surgery Unit- University of Florence
(Eur J Vasc Endovasc Surg, 2014)
Vascular and Endovascular Surgery Unit- University of Florence
(Ann Vasc Surg, 2010)
Vascular and Endovascular Surgery Unit- University of Florence
(J Vasc Surg 2017)
Vascular and Endovascular Surgery Unit- University of Florence
(Eur J Vasc Endovasc Surg, 2013)
Vascular and Endovascular Surgery Unit- University of Florence(Joshi et al., 2014)
Vascular and Endovascular Surgery Unit- University of Florence
CHIRURGIA OPEN vs ENDOVASCOLARE
STUDIO CASO – CONTROLLO “EXACT
MATCHING”
SCOPO DELLO
STUDIO
Vascular and Endovascular Surgery Unit- University of Florence
1981-2015, 309 interventi PAA
MATERIALI E
METODI
Vascular and Endovascular Surgery Unit- University of Florence
MATERIALI E
METODI
59
250OPEN vs ENDO
Endovascular Repair Open Repair
POPOLAZIONI EQUIVALENTI: 56 ENDOVASCULAR REPAIR Vs 56 OPEN REPAIR
Vascular and Endovascular Surgery Unit- University of Florence
OR (56) ER (56) p
Sesso M 55 (98%) 56 (100%) 0.8
Età 71.6±10.3 74.1±7.1 0.06
CAD 23 (41%) 20 (36%) 0.3
BPCO 26 (46%) 22 (39%) 0.4
Diabete 7 (12.5%) 4 (7%) 0.3
Ipertensione 49 (87%) 49 (87%) 1
Dislipidemia 25 (45%) 22 (39%) 0.5
CARATTERISTICHE DEL GRUPPO DI
STUDIO
Demografiche, Fattori di rischio e Comorbidità
Vascular and Endovascular Surgery Unit- University of Florence
OR (56) ER (56) p
Asintomatici PAA 38 (68%) 38 (68%) 1
Sintomatici PAA 18 (32%) 18 (32%) 1
Ischemia acuta 5 (9%) 8 (14%) 0.3
Trombosati PAA 9 (16%) 9 (16%) 1
Trombolisi preoperatoria 3 (6%) 8 (14%) 0.1
Run off distale < 2 vasi 11 (20%) 11 (20%) 1
Diametro PAA (mm) 32.5±11.2 32.9±12.7 0.9
CARATTERISTICHE DEL GRUPPO DI
STUDIO
Cliniche e Anatomiche
Vascular and Endovascular Surgery Unit- University of Florence
RISULTATI
PERIOPERATORI
OR (56) ER (56) p
Mortalità - 1 (1.7%) 0.3
Trombosi 4 (7%) 2 (3.5%) 0.4
Amputazione 2 (3.5%) - 0.1
Reintervento 3 (5%) 3 (5%) 0.7
Degenza media (gg) 5.7 ± 3.3 3.2 ± 1.1 <0.001
Vascular and Endovascular Surgery Unit- University of Florence
FOLLOW UP MEDIO: 53 mesi (range, 1-312- FU index 65%)
71 mesi OR Vs 36 mesi ER; p <0.001)
P=0.9, log rank 0.01; SE 0.07, 0.08 @ 4 yrs.P=0.4, log rank 0.6; SE 0.06, 0.08 @ 4 yrs.
Months
RISULTATI
TARDIVI
Vascular and Endovascular Surgery Unit- University of Florence
P=0.3, log rank 1.1; SE 0.07, 0.08 @ 4 yrs.P=0.9, log rank 0.01; SE 0.07, 0.08 @ 4 yrs.
RISULTATI
TARDIVI
Vascular and Endovascular Surgery Unit- University of Florence
Reinterventi OR (56) ER (56) p
OR per trombosi 7 (12.5%) 6 (10.7%) 0.3
OR non per trombosi*
1 (1.7%) - 0.4
Trombolisi
e ER2 (3.5%) 8 (14.3%) 0.04
ER non per trombosi**
- 2 (3.5%) 0.2
Overall 10 (17.8%) 16 (28.6%) 0.06
* Pseudoaneurismi anastomotici e progressione aneurismatica distale
** Endoleak tipo II 62.5%70%
RISULTATI
TARDIVI
Vascular and Endovascular Surgery Unit- University of Florence
• Nella nostra esperienza OR e ER mostrano similirisultati perioperatori e a lungo termine in gruppiequivalenti di pazienti.
• Maggior rischio di reintervento nei pazienti con trattamento endovascolare, ma risolvibili per la gran parte con mininvasità.
• Scelta della strategia terapeutica sul paziente.
CONCLUSIONI