Rafii Benjamin Y, Abilez Oscar J, Benharash Peyman, Zarins Christopher K
Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
J Endovasc Ther. 2008 Jun;15(3):335-43. doi: 10.1583/08-2422.1.
To determine if lateral movement of an aortic endograft 1 year following endovascular abdominal aortic aneurysm (AAA) repair is an indicator of endograft instability and can serve as a predictor of late adverse events.
The records of 60 high-risk AAA patients (52 men, 8 women; mean age 74 years) who were treated with infrarenal (n = 38) or suprarenal (n = 22) endografts and had serial computed tomograms (CT) over > or =12 months were analyzed. Postimplantation and 1-year CT scans were compared, and changes in endograft position within the aneurysm sac [lateral movement (LM) versus no lateral movement (NM)] were measured using a vertebral body reference point. Longitudinal endograft movement was measured with respect to the superior mesenteric artery along the aortic centerline axis. Long-term adverse event rates (endoleaks, secondary procedures, conversion, rupture, and death) were assessed.
One year after endograft implantation, LM > or =5 mm was present in 16 (27%) patients; 44 (73%) endografts demonstrated no lateral movement. LM patients had larger aneurysms (6.5+/-1.5 versus 5.6+/-0.9 cm, p = 0.02) and a longer endograft-to-hypogastric artery length (p = 0.01) than NM patients. There were no significant differences between patients treated with infrarenal and suprarenal endografts. At 1 year, longitudinal migration > or =10 mm occurred in 5 (31%) of the LM patients versus 2 (5%) in the NM cohort (p<0.0001). There were no significant differences in adverse event rates between LM and NM at 1 year. However, during long-term follow-up (mean 54+/-26 months, range 12-102), 8 (50%) LM patients developed a type I endoleak versus 8 (18%) NM patients (p = 0.02), and 12 (75%) LM patients required a secondary procedure versus 9 (20%) NM patients (p = 0.0002). One (6%) LM patient experienced aneurysm rupture and 2 (13%) other LM patients underwent conversion to open repair.
Lateral endograft movement within the aneurysm sac at 1 year is associated with increased risk of late adverse events and was at least as good a predictor of these complications as was longitudinal migration.
确定血管腔内腹主动脉瘤（AAA）修复术后1年主动脉腔内移植物的侧向移动是否为移植物不稳定的指标，并能否作为晚期不良事件的预测因素。
分析60例高危AAA患者（52例男性，8例女性；平均年龄74岁）的记录，这些患者接受了肾下（n = 38）或肾上（n = 22）腔内移植物治疗，并在≥12个月内进行了系列计算机断层扫描（CT）。比较植入后和1年时的CT扫描，并使用椎体参考点测量动脉瘤腔内移植物位置的变化[侧向移动（LM）与无侧向移动（NM）]。沿主动脉中心线轴相对于肠系膜上动脉测量移植物的纵向移动。评估长期不良事件发生率（内漏、二次手术、转换、破裂和死亡）。
腔内移植物植入1年后，16例（27%）患者出现LM≥5 mm；44例（73%）移植物无侧向移动。与NM患者相比，LM患者的动脉瘤更大（6.5±1.5对5.6±0.9 cm，p = 0.02），移植物至下腹动脉长度更长（p = 0.01）。肾下和肾上腔内移植物治疗的患者之间无显著差异。1年时，LM患者中有5例（31%）发生纵向迁移≥10 mm，而NM组为2例（5%）（p<0.0001）。1年时，LM和NM患者的不良事件发生率无显著差异。然而，在长期随访（平均54±26个月，范围12 - 102个月）期间，8例（50%）LM患者发生I型内漏，而NM患者为8例（18%）（p = 0.02），12例（75%）LM患者需要二次手术，而NM患者为9例（20%）（p = 0.0002）。1例（6%）LM患者发生动脉瘤破裂，另外2例（13%）LM患者转为开放修复。
1年时动脉瘤腔内移植物的侧向移动与晚期不良事件风险增加相关，并且至少与纵向迁移一样是这些并发症的良好预测因素。
