Melissano Germano, Bertoglio Luca, Esposito Gloria, Civilini Efrem, Setacci Francesco, Chiesa Roberto
Vita-Salute University, Scientific Institute H. San Raffaele, Milan, Italy.
J Vasc Surg. 2005 Dec;42(6):1052-7. doi: 10.1016/j.jvs.2005.05.009.
Recent studies have reported different sac behavior after endovascular repair of abdominal aortic aneurysms, depending on the endografts. This study was designed to evaluate mid-term outcome and sac behavior after treatment with the Gore Excluder stent-graft.
Between June 1999 and January 2005, 109 selected patients with suitable anatomy were treated electively for abdominal aortic aneurysm with the Excluder stent graft. Data were prospectively collected in a computerised database and included demographics, details of the aortoiliac anatomy, procedural and clinical success, and postoperative complications. Postoperative sac size and the presence of endoleaks were assessed with computed tomography scans obtained at 1, 6, and 12 months, and yearly thereafter. All diameter measures in patients followed for > 1 year (84.4%) were analyzed.
Assisted primary technical success was achieved in 108 cases (99.1%). No type I endoleaks and 12 (11.1%) type II endoleaks were recorded < or = 1 month from the procedure. Mean follow-up was 29.6 +/- 16.1 months. We recorded one new-onset type IA endoleak, complete resolution of five type II endoleaks, and eight new-onset type II endoleaks. The overall prevalence of type II endoleaks was 14%. Shrinkage at 1, 2, 3, and 4 years was observed in 20.7%, 30.5%, 38.9%, and 36.8% of cases. The presence of type II endoleak influenced the trend of aneurysm size throughout the 4 years. Aneurysms without endoleak shrank more than aneurysms with type II endoleak (P < .0001). We observed two cases of sac enlargement due to the presence of endoleaks. No cases of endotension with sac enlargement, late open conversion, or aneurysm-related deaths were observed. Unchanged aneurysmal sacs remained stable during follow-up, with no adverse events.
Endovascular treatment with the Excluder device in selected patients produces low rates of shrinkage, but this peculiar sac behavior does not affect mid-term clinical success.
近期研究报道，腹主动脉瘤腔内修复术后，根据不同的腔内移植物，瘤腔表现各异。本研究旨在评估使用戈尔覆膜支架移植物治疗后的中期疗效及瘤腔表现。
1999年6月至2005年1月期间，109例解剖结构合适的患者接受了择期腹主动脉瘤戈尔覆膜支架移植物治疗。数据前瞻性收集于计算机数据库，包括人口统计学资料、主髂动脉解剖细节、手术及临床成功率、术后并发症。术后1、6、12个月及此后每年行计算机断层扫描，评估瘤腔大小及内漏情况。对随访时间>1年的患者（84.4%）的所有直径测量值进行分析。
108例（99.1%）患者获得辅助性一期技术成功。术后≤1个月时，未发现Ⅰ型内漏，记录到12例（11.1%）Ⅱ型内漏。平均随访时间为29.6±16.1个月。我们记录到1例新发ⅠA型内漏，5例Ⅱ型内漏完全消失，8例新发Ⅱ型内漏。Ⅱ型内漏的总体发生率为14%。1年、2年、3年和4年时瘤腔缩小的病例分别占20.7%、30.5%、38.9%和36.8%。Ⅱ型内漏的存在影响了整个4年期间动脉瘤大小的变化趋势。无内漏的动脉瘤比有Ⅱ型内漏的动脉瘤缩小更明显（P<0.0001）。我们观察到2例因内漏导致瘤腔增大的病例。未观察到因瘤腔内张力增大、晚期开放转换或动脉瘤相关死亡的病例。随访期间，不变的动脉瘤瘤腔保持稳定，无不良事件发生。
在选定患者中使用戈尔覆膜支架移植物进行血管腔内治疗，瘤腔缩小率较低，但这种特殊的瘤腔表现不影响中期临床疗效。
