Bent Clare L, Fotiadis Nikolas, Renfrew Ian, Walsh Michael, Brohi Karim, Kyriakides Constantinos, Matson Matthew
Department of Diagnostic Imaging, Barts and The London NHS Trust, Whitechapel, London, E1 1BB, UK.
Cardiovasc Intervent Radiol. 2009 May;32(3):449-54. doi: 10.1007/s00270-009-9537-3. Epub 2009 Mar 19.
The purpose of this study was to examine the immediate and midterm outcomes of percutaneous endovascular repair of thoracic and abdominal aortic pathology. Between December 2003 and June 2005, 21 patients (mean age: 60.4 +/- 17.1 years; 15 males, 6 females) underwent endovascular stent-graft insertion for thoracic (n = 13) or abdominal aortic (n = 8) pathology. Preprocedural computed tomographic angiography (CTA) was performed to assess the suitability of aorto-iliac and common femoral artery (CFA) anatomy, including the degree of CFA calcification, for total percutaneous aortic stent-graft repair. Percutaneous access was used for the introduction of 18- to 26-Fr delivery devices. A 'preclose' closure technique using two Perclose suture devices (Perclose A-T; Abbott Vascular) was used in all cases. Data were prospectively collected. Each CFA puncture site was assessed via clinical examination and CTA at 1, 6, and 12 months, followed by annual review thereafter. Minimum follow-up was 36 months. Outcome measures evaluated were rates of technical success, conversion to open surgical repair, complications, and late incidence of arterial stenosis at the site of Perclose suture deployment. A total of 58 Perclose devices were used to close 29 femoral arteriotomies. Outer diameters of stent-graft delivery devices used were 18 Fr (n = 5), 20 Fr (n = 3), 22 Fr (n = 4), 24 Fr (n = 15), and 26 Fr (n = 2). Percutaneous closure was successful in 96.6% (28/29) of arteriotomies. Conversion to surgical repair was required at one access site (3.4%). Mean follow-up was 50 +/- 8 months. No late complications were observed. By CT criteria, no patient developed a >50% reduction in CFA caliber at the site of Perclose deployment during the study period. In conclusion, percutaneous aortic stent-graft insertion can be safely performed, with a low risk of both immediate and midterm access-related complications.
本研究的目的是探讨经皮血管腔内修复胸主动脉和腹主动脉病变的近期和中期疗效。2003年12月至2005年6月期间，21例患者（平均年龄：60.4±17.1岁；男15例，女6例）接受了血管腔内支架移植物植入术，用于治疗胸主动脉病变（n = 13）或腹主动脉病变（n = 8）。术前进行计算机断层血管造影（CTA），以评估腹主动脉-髂动脉和股总动脉（CFA）的解剖结构是否适合完全经皮主动脉支架移植物修复，包括CFA钙化程度。采用经皮穿刺法引入18至26 Fr的输送装置。所有病例均采用使用两个Perclose缝合装置（Perclose A-T；雅培血管公司）的“预闭合”闭合技术。前瞻性收集数据。在1、6和12个月时通过临床检查和CTA评估每个CFA穿刺部位，此后每年复查一次。最短随访时间为36个月。评估的结局指标包括技术成功率、转为开放手术修复的比例、并发症以及Perclose缝合部位动脉狭窄的晚期发生率。总共使用58个Perclose装置闭合29处股动脉切开术。所使用的支架移植物输送装置的外径分别为18 Fr（n = 5）、20 Fr（n = 3）、22 Fr（n = 4）、24 Fr（n = 15）和26 Fr（n = 2）。96.6%（28/29）的动脉切开术经皮闭合成功。一个穿刺部位（3.4%）需要转为手术修复。平均随访时间为50±8个月。未观察到晚期并发症。根据CT标准，在研究期间，没有患者在Perclose缝合部位出现CFA管径缩小>50%的情况。总之，经皮主动脉支架移植物植入术可以安全进行，近期和中期与穿刺相关的并发症风险较低。
