Pitton Michael B, Scheschkowski Tobias, Ring Markus, Herber Sascha, Oberholzer Katja, Leicher-Düber Annegret, Neufang Achim, Schmiedt Walther, Düber Christoph
Department of Diagnostic and Interventional Radiology, University Hospital of Mainz, Johannes Gutenberg University of Mainz, Mainz, Germany.
Cardiovasc Intervent Radiol. 2009 Sep;32(5):906-17. doi: 10.1007/s00270-009-9599-2. Epub 2009 Jul 28.
The purpose of this study was to evaluate the clinical results, complications, and secondary interventions during long-term follow-up after endovascular aneurysm repair (EVAR) and to investigate the impact of endoleak sizes on aneurysm shrinkage. From 1997 to March 2007, 127 patients (12 female, 115 male; age, 73.0 +/- 7.2 years) with abdominal aortic aneurysms were treated with Talent stent-grafts. Follow-up included clinical visits, contrast-enhanced MDCT, and radiographs at 3, 6, and 12 months and then annually. Results were analyzed with respect to clinical outcome, secondary interventions, endoleak rate and management, and change in aneurysm size. There was no need for primary conversion surgery. Thirty-day mortality was 1.6% (two myocardial infarctions). Procedure-related morbidity was 2.4% (paraplegia, partial infarction of one kidney, and inguinal bleeding requiring surgery). Mean follow-up was 47.7 +/- 34.2 months (range, 0-123 months). Thirty-nine patients died during follow-up; three of the deaths were related to aneurysm (aneurysm rupture due to endoleak, n = 1; secondary surgical reintervention n = 2). During follow-up, a total of 29 secondary procedures were performed in 19 patients, including 14 percutaneous procedures (10 patients) and 15 surgical procedures (12 patients), including 4 cases with late conversion to open aortic repair (stent-graft infection, n = 1; migration, endoleak, or endotension, n = 3). Overall mean survival was 84.5 +/- 4.7 months. Mean survival and freedom from any event was 66.7 +/- 4.5 months. MRI depicted significantly more endoleaks compared to MDCT (23.5% vs. 14.3%; P < 0.01). Patients in whom all aneurysm side branches were occluded prior to stent-grafting showed a significantly reduced incidence of large endoleaks. Endoleaks >10% of the aneurysm area were associated with reduced aneurysm shrinkage compared to no endoleaks or <10% endoleaks (Delta at 3 years, -1.8% vs. -12.0%; P < 0.05). In conclusion, endovascular aneurysm treatment with Talent stent-grafts demonstrated encouraging long-term results with moderate secondary intervention rates. Primary occlusion of all aortic side branches reduced the incidence of large endoleaks. Large endoleaks significantly impaired aneurysm shrinkage, whereas small endoleaks did not.
本研究的目的是评估血管内动脉瘤修复术（EVAR）长期随访期间的临床结果、并发症及二次干预情况，并探讨内漏大小对动脉瘤缩小的影响。1997年至2007年3月，127例腹主动脉瘤患者（12例女性，115例男性；年龄73.0±7.2岁）接受了Talent覆膜支架治疗。随访包括3、6和12个月时以及之后每年的临床检查、增强MDCT和X线检查。分析了临床结局、二次干预、内漏率及处理情况以及动脉瘤大小的变化。无需进行一期转换手术。30天死亡率为1.6%（2例心肌梗死）。与手术相关的发病率为2.4%（截瘫、一侧肾部分梗死以及腹股沟出血需手术治疗）。平均随访时间为47.7±34.2个月（范围0 - 123个月）。39例患者在随访期间死亡；其中3例死亡与动脉瘤相关（因内漏导致动脉瘤破裂1例；二次手术再干预2例）。随访期间，19例患者共进行了29次二次手术，包括14次经皮手术（10例患者）和15次外科手术（12例患者），其中4例为晚期转为开放主动脉修复术（支架移植物感染1例；移位、内漏或内张力3例）。总体平均生存期为84.5±4.个月。无任何事件发生的平均生存期为66.7±4.5个月。与MDCT相比，MRI显示的内漏明显更多（23.5%对14.3%；P<0.01）。在植入支架前所有动脉瘤侧支均被闭塞的患者中，大内漏的发生率显著降低。与无内漏或内漏<10%相比，内漏>动脉瘤面积10%与动脉瘤缩小减少相关（3年时的变化，-1.8%对-12.0%；P<0.05）。总之，使用Talent覆膜支架进行血管内动脉瘤治疗显示出令人鼓舞的长期结果，二次干预率适中。所有主动脉侧支的一期闭塞降低了大内漏的发生率。大内漏显著损害动脉瘤缩小，而小内漏则不然。
