Malas Mahmoud B, Ohki Takao, Veith Frank J, Chen Tina, Lipsitz Evan C, Shah Amit R, Timaran Carlos, Suggs William, Gargiulo Nicholas J, Parodi Juan C
Division of Vascular Surgery, Montefiore Medical Center, The Albert Einstein College of Medicine, New York, NY, USA.
J Vasc Surg. 2005 Oct;42(4):639-44. doi: 10.1016/j.jvs.2005.06.017.
Proximal neck dilatation (PND) and/or endograft migration with the subsequent development of type I endoleak is a significant cause of late endograft failure after endovascular abdominal aortic aneurysm repair (EVAR). Although there are numerous reports examining PND in patients receiving endografts that use self-expanding stents (SES) for proximal fixation, there are no such reports for patients treated with endografts that use balloon-expanding stents (BES). The purpose of this study was to investigate PND and endograft migration after EVAR with BES endografts.
We retrospectively reviewed all charts and all serial computed tomographic scans available for patients who underwent EVAR with a BES endograft (surgeon-made, aortounifemoral polytetrafluoroethylene graft with a proximal Palmaz stent) between August 1997 and October 2002. Only patients with longer than a 12-month follow-up were analyzed. Neck diameter was measured at the level of the lowest renal artery and at 5 mm below it. PND was defined as neck enlargement of 2.5 mm or more. To assess endograft migration, the distance between the superior mesenteric artery and the cranial end of the BES was measured. Stent migration was defined as a change of 5 mm or more.
A total of 77 patients received this device during the study period. The technical success rate was 99%. The 1-, 3-, and 5-year survival was 66%, 48%, and 29.5%, respectively. Complete serial computed tomographic scans were available in 41 of the 48 patients who survived 12 months or longer after the operation. The mean follow-up period for these patients was 31 months (range, 12-66 months). The maximum aneurysm diameter was either unchanged or decreased in 35 patients (85%). The immediate postoperative proximal neck diameter was 19 to 29 mm (median, 24 mm). This was unchanged at the latest follow-up. None of the patients had significant PND. The cranial end of the BES was located in the area between 14 mm proximal and 36 mm distal to the superior mesenteric artery (median, 6 mm). None of the patients developed significant endograft migration.
Neither PND nor endograft migration was observed with the BES endograft. The nature of the SES may be responsible for the observed neck dilatation and device migration after EVAR with SES endografts. This study suggests that BES may be a better fixation method for EVAR.
近端颈部扩张（PND）和/或血管内移植物移位并随后发生Ⅰ型内漏是血管腔内腹主动脉瘤修复术（EVAR）后晚期血管内移植物失败的重要原因。尽管有许多报告研究了使用自膨式支架（SES）进行近端固定的血管内移植物患者的PND，但对于使用球囊扩张式支架（BES）的血管内移植物治疗的患者，尚无此类报告。本研究的目的是调查使用BES血管内移植物的EVAR术后的PND和血管内移植物移位情况。
我们回顾性分析了1997年8月至2002年10月期间接受BES血管内移植物（外科自制，带近端Palmaz支架的主动脉-单侧股动脉聚四氟乙烯移植物）进行EVAR的患者的所有病历和所有系列计算机断层扫描。仅分析随访时间超过12个月的患者。在最低肾动脉水平及其下方5 mm处测量颈部直径。PND定义为颈部增大2.5 mm或更多。为了评估血管内移植物移位，测量肠系膜上动脉与BES头端之间的距离。支架移位定义为变化5 mm或更多。
在研究期间共有77例患者接受了该装置。技术成功率为99%。1年、3年和5年生存率分别为66%、48%和29.5%。在术后存活12个月或更长时间的48例患者中，有41例获得了完整的系列计算机断层扫描。这些患者的平均随访期为31个月（范围12 - 66个月）。35例患者（85%）的最大动脉瘤直径未改变或减小。术后即刻近端颈部直径为19至29 mm（中位数为24 mm）。在最近一次随访时这一数值未变。没有患者出现明显的PND。BES的头端位于肠系膜上动脉近端14 mm至远端36 mm之间的区域（中位数为6 mm）。没有患者发生明显的血管内移植物移位。
使用BES血管内移植物未观察到PND和血管内移植物移位。SES的特性可能是使用SES血管内移植物的EVAR术后观察到的颈部扩张和装置移位的原因。本研究表明，BES可能是EVAR更好的固定方法。
