Blum U, Hauer M, Pfammatter T, Voshage G
Department of Diagnostic Radiology, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
World J Surg. 2001 Mar;25(3):347-52; discussion 353-4. doi: 10.1007/s002680020382. Epub 2001 Apr 11.
The purpose of this study was to define the clinical utility of stent-grafts for endoluminal treatment of infrarenal abdominal aortic aneurysms (AAAs). In a prospective study involving three centers, bifurcated stent-grafts for endovascular repair of infrarenal AAAs were implanted in 295 patients. Patient selection was based on anatomic suitability. For analysis of the initial and follow-up results the patients were divided in three subgroups. Group 1 included patients treated between August 1994 and April 1996 with use of the original stent-graft device; group 2 comprised patients treated between May 1996 and December 1997 with the refined stent-graft device, and group 3 comprised patients treated with a newly designed bifurcated stent-graft device. In group 1 (n = 111) the primary technical success was 82%. The procedure had to be converted to surgery in four patients. Endoleaks immediately after the procedure were observed in 16 patients. The initial technical success in subgroup 2 (n = 159) was 96%. One patient required surgical repair, and five others had immediate perigraft flow due to reperfusion via lumbar arteries. For group 3 (n = 28) the primary technical success rate was 89%. Endoleaks due to back-bleeding via lumbar arteries were demonstrated in three patients. Minor and major complications related to the intervention, including two perioperative deaths, were observed in 24 patients (8%). Serious problems such as distal migration or disconnection of the stent-graft were detected during follow-up in five patients. Delayed aortic rupture occurred in three patients who survived after successful surgical repair. Based on the initial results and a limited follow-up of 35 months, we believe endoluminal repair of infrarenal AAA with use of bifurcated endografts may be a feasible alternative to conventional surgery, especially for patients at high surgical risk. However, at the present time there are major concerns with respect to the structural integrity of stent-graft material and the fate of the proximal aortic cuff in the long-term time frame.
本研究的目的是确定支架型人工血管用于肾下腹主动脉瘤（AAA）腔内治疗的临床效用。在一项涉及三个中心的前瞻性研究中，为295例患者植入了用于肾下AAA血管腔内修复的分叉型支架型人工血管。患者选择基于解剖学适宜性。为分析初始和随访结果，将患者分为三个亚组。第1组包括1994年8月至1996年4月期间使用原始支架型人工血管装置治疗的患者；第2组包括1996年5月至1997年12月期间使用改良支架型人工血管装置治疗的患者，第3组包括使用新设计的分叉型支架型人工血管装置治疗的患者。在第1组（n = 111）中，主要技术成功率为82%。4例患者的手术不得不转为开放手术。术后即刻有16例患者出现内漏。第2亚组（n = 159）的初始技术成功率为96%。1例患者需要手术修复，另外5例因通过腰动脉再灌注而出现移植物周围即刻血流。第3组（n = 28）的主要技术成功率为89%。3例患者出现因腰动脉回血导致的内漏。24例患者（8%）观察到与干预相关的轻微和严重并发症，包括2例围手术期死亡。随访期间在5例患者中检测到诸如支架型人工血管远端移位或脱节等严重问题。3例成功手术修复后存活的患者发生了延迟性主动脉破裂。基于初始结果和35个月的有限随访，我们认为使用分叉型腔内移植物对肾下AAA进行腔内修复可能是传统手术的一种可行替代方案，尤其是对于手术风险高的患者。然而，目前在支架型人工血管材料的结构完整性以及长期内近端主动脉袖口的转归方面存在重大担忧。
