Higashiura Wataru, Sakaguchi Shoji, Kichikawa Kimihiko, Kubota Yasushi, Nagata Takeshi, Tabayashi Nobuoki, Taniguchi Shigeki, Uchida Hideo
Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, Japan.
J Vasc Interv Radiol. 2008 Jun;19(6):848-54. doi: 10.1016/j.jvir.2008.02.026. Epub 2008 Apr 18.
To clarify whether the ipsilateral limb level of the main body of the graft above or below the aortic bifurcation affects midterm outcomes of endovascular abdominal aortic aneurysm repair (EVAR) with the Zenith abdominal aortic aneurysm endovascular graft.
The authors analyzed 70 consecutive patients treated with the Zenith endograft between 1999 and 2006 with a retrospective review of prospectively collected clinical and imaging data. Patients were divided into two groups--those in whom the ipsilateral limb of the main body was placed above the aortic bifurcation (group A, n = 34) and those in whom the ipsilateral limb of the main body was placed below the aortic bifurcation (group B, n = 36). The frequency of sac enlargement, late type I or III endoleak, and secondary intervention and freedom from major adverse events associated with an aneurysm were compared.
The median follow-up was 38 months (range, 1-84 months). The frequency of sac enlargement was 12% (four of 34 patients) in group A and 8% (three of 36 patients, P = .94) in group B. The frequency of late type I or III endoleak was 9% (three of 34 patients) in group A and 6% (two of 36 patients, P = .95) in group B. The frequency of secondary intervention was 15% (five of 34 patients) in group A and 6% (two of 36 patients, P = .38) in group B. Rate of freedom from major adverse events at 60-month follow-up was 62% in group A and 80% in group B (P = .54).
Placement of the ipsilateral limb of the main body above the aortic bifurcation should be considered as one option in patients with an inadequate iliac anatomy at this time. Further follow-up and accumulation of patients will help clarify outcomes with regard to differences in ipsilateral limb level.
明确使用Zenith腹主动脉瘤腔内移植物进行血管腔内腹主动脉瘤修复术（EVAR）时，移植物主体同侧肢体位于主动脉分叉上方或下方是否会影响中期疗效。
作者回顾性分析了1999年至2006年间连续70例接受Zenith腔内移植物治疗的患者，对前瞻性收集的临床和影像学数据进行回顾。患者分为两组——主体同侧肢体置于主动脉分叉上方的患者（A组，n = 34）和主体同侧肢体置于主动脉分叉下方的患者（B组，n = 36）。比较两组瘤囊增大、晚期I型或III型内漏的发生率、二次干预情况以及与动脉瘤相关的主要不良事件的发生情况。
中位随访时间为38个月（范围1 - 84个月）。A组瘤囊增大的发生率为12%（34例患者中的4例），B组为8%（36例患者中的3例，P = 0.94）。A组晚期I型或III型内漏的发生率为9%（34例患者中的3例），B组为6%（36例患者中的2例，P = 0.95）。A组二次干预的发生率为15%（34例患者中的5例），B组为6%（36例患者中的2例，P = 0.38）。60个月随访时，A组无主要不良事件的发生率为62%，B组为80%（P = 0.54）。
对于此时髂部解剖结构不适合的患者，可将主体同侧肢体置于主动脉分叉上方作为一种选择。进一步的随访和患者积累将有助于明确同侧肢体位置差异对疗效的影响。
