Qu L, Hetzel G, Raithel D
Department of Vascular and Endovascular Surgery Nuernberg Hospital, Nuernberg, Germany.
J Cardiovasc Surg (Torino). 2007 Feb;48(1):13-9.
To assess the 7-year results of endovascular aortic aneurysm repair using the Powerlink unibody bifurcated endovascular stent-graft in our single center.
A prospective, nonrandomized trial was conducted in our unit within 7 years. Endovascular aortic aneurysm repair (EVAR) was planned, performed and followed-up by a fixed endovascular specialized group, including 2 vascular surgeons and 1 interventional radiologist. All the relative data were input into the SPSS statistical analysis software. All patients received abdomen X-ray plain films and CTs or duplex before discharge and 1 month, 6 months, 1 year after discharge, and then annually.
From February 1999 to September 2006, a total of 378 abdominal aortic aneurysms (AAAs) patients were intended to treat with Powerlink device, 372 cases were implanted successfully, the technical success rate was 98.4%. The average operation time was 66 min (range, 35-150 min). The late 210 cases (56.5%) were implanted sitting on the aortic bifurcation, the other 162 early cases (43.5%) were not implanted sitting on the aortic bifurcation, proximal cuff was implanted in 209 cases (56.2%), and distal limb extension was used in 42 cases (11.3%), 22 cases (5.9%) received Palmaz stent. One hundred and ninety- four cases (52.2%) had infrarenal fixation, 178 cases (47.8%) had suprarenal fixation. Intraoperative complications included immediate conversion in 6 cases (1.6%), primary proximal type I endoleak in 8 cases (2.2%), primary distal type I endoleak in 2 cases (0.5%), type II endoleak occurred in 20 cases (5.4%). Mean follow-up was 26.7 months (range 1 month 7 years). Postoperative complications included secondary type I endoleaks in 10 cases (2.7%), secondary type II endoleaks in 9 cases (2.4%), limb occlusion in 8 cases and limb stenosis in 5 cases, endograft limb kinking/twisting in 2 cases, partial renal infarction in 9 cases (2.4%). A total of 7 cases (1.9%) had distal migration and all 7 cases were not implanted sitting on the aortic bifurcation. Post-EVAR conversion occurred in 6 cases (1.6%). There were a total of 18 deaths (4.8/%) and 6 deaths (1.6%) within 30 days.
The Powerlink device is safe and effective in preventing AAA rupture in mid-term. It proved simple and easy for size choice. The unique design of this device may confer some advantages in terms of durability. The distinct anatomic fixation of stent-graft sitting on the aortic bifurcation simplifies the deployment procedures and minimizes the potential of distal migration. Prospective longer follow-up in multicenter randomized controlled larger series is necessary to confirm the encouraging outcomes.
评估在我们单中心使用Powerlink一体式分叉型血管内支架型人工血管进行血管腔内主动脉瘤修复术的7年结果。
我们单位在7年内进行了一项前瞻性、非随机试验。血管腔内主动脉瘤修复术（EVAR）由一个固定的血管内专业团队计划、实施并随访，该团队包括2名血管外科医生和1名介入放射科医生。所有相关数据输入SPSS统计分析软件。所有患者在出院时、出院后1个月、6个月、1年，然后每年接受腹部X线平片、CT或双功超声检查。
从1999年2月至2006年9月，共有378例腹主动脉瘤（AAA）患者拟用Powerlink装置治疗，372例成功植入，技术成功率为98.4%。平均手术时间为66分钟（范围35 - 150分钟）。210例晚期患者（56.5%）的支架植入于主动脉分叉处，另外162例早期患者（43.5%）的支架未植入于主动脉分叉处，209例（56.2%）植入了近端袖套，42例（11.3%）使用了远端肢体延长装置，22例（5.9%）接受了Palmaz支架。194例（52.2%）为肾下固定，178例（47.8%）为肾上固定。术中并发症包括6例（1.6%）即刻中转开放手术，8例（2.2%）原发性近端I型内漏，2例（0.5%）原发性远端I型内漏，20例（5.4%）发生II型内漏。平均随访26.7个月（范围1个月至7年）。术后并发症包括10例（2.7%）继发性I型内漏，9例（2.4%）继发性II型内漏，8例肢体闭塞和5例肢体狭窄，2例移植物肢体扭结/扭曲，9例（2.4%）部分肾梗死。共有7例（1.9%）发生远端移位，所有7例均未植入于主动脉分叉处。EVAR术后中转开放手术6例（1.6%）。共有18例死亡（4.8%），30天内死亡6例（1.6%）。
Powerlink装置在中期预防AAA破裂方面安全有效。其尺寸选择简单易行。该装置的独特设计可能在耐久性方面具有一些优势。支架型人工血管在主动脉分叉处独特的解剖固定方式简化了植入过程，并将远端移位的可能性降至最低。需要进行多中心随机对照大样本系列的前瞻性长期随访以证实这些令人鼓舞的结果。
