移植物在动脉瘤腔内的横向移动是支架型人工血管不稳定的一个指标。

Lateral movement of endografts within the aneurysm sac is an indicator of stent-graft instability.

作者信息

Rafii Benjamin Y, Abilez Oscar J, Benharash Peyman, Zarins Christopher K

机构信息

Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.

出版信息

J Endovasc Ther. 2008 Jun;15(3):335-43. doi: 10.1583/08-2422.1.

DOI:10.1583/08-2422.1

PMID:18540708

Abstract

PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

摘要

目的

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。

方法

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）。

结果

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。