不同自膨式覆膜支架类型对血管内动脉瘤修复后主动脉颈重塑的影响。

Influence of different self-expanding stent-graft types on remodeling of the aortic neck after endovascular aneurysm repair.

机构信息

Department of Thoracic and Vascular Surgery, University of Ulm, Germany.

出版信息

J Endovasc Ther. 2010 Dec;17(6):677-84. doi: 10.1583/10-3172.1.

DOI:10.1583/10-3172.1

PMID:21142472

Abstract

PURPOSE

To evaluate aortic neck changes, specifically aortic neck dilatation, over a 10-year period in patients undergoing endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm.

METHODS

All patients who underwent elective EVAR at our institution from 1998 through 2007 were analyzed retrospectively. Among these, 103 patients (96 men; mean age 71 years, range 35-84) who received the 3 most frequently implanted self-expanding stent-grafts (35 Talent, 39 Excluder, and 29 Zenith) and had a minimum 3-month imaging follow-up at our department were selected for this study. All diameters were measured perpendicular to the centerline of flow on computed tomography; baseline data were derived from the first postoperative scan. Stent-graft migration was measured from the lowermost renal artery to the first strut of the stent-graft. Based on intra- and interobserver error measurements, a minimum change of 2 mm defined aortic neck dilatation.

RESULTS

During a mean follow-up of 39.4 months (range 3-108.8), infrarenal aortic neck dilatation (>2 mm) was found in 10 patients (28.6%, 95% CI 14.6-46.3) in the Talent group, 4 (10.3%, 95% CI 2.9-24.2) in the Excluder group, and 9 (31.0%, 95% CI 15.3-50.8) in the Zenith group (p=0.299). In 7 (31%) of the 23 patients with neck dilatation, additional therapy was necessary. Suprarenal changes were found in 6 patients (17.1%, 95% CI 6.6-33.6), 8 patients (20.5%, 95% CI 9.3-36.5), and 5 patients (17.2%, 95% CI 5.8-35.8), respectively (p=0.218). Stent-graft migration >2 mm was seen in 2 (1.9%) of the 103 patients in follow-up. The overall endoleak rates were 37.1% for Talent, 30.8% for Excluder, and 37.9% for Zenith (p>0.05). Two patients were converted to open repair owing to Talent stent-graft migration and persistent type I leak (Zenith). The overall reintervention rate was 13.6% (13/103).

CONCLUSION

Only a small number of the patients treated with self-expanding stent-grafts show notable infrarenal aortic neck dilatation, which does not appear to be related to the stent-graft model. Almost all cases of aortic neck dilatation exceeded the percentage of oversizing; less than a third of patients with aortic neck dilatation required therapy.

摘要

目的

评估 10 年内接受腹主动脉瘤血管内修复（EVAR）的患者的主动脉颈变化，特别是主动脉颈扩张。

方法

回顾性分析 1998 年至 2007 年期间在我院行择期 EVAR 的所有患者。其中，选择了 103 名（96 名男性；平均年龄 71 岁，范围 35-84 岁）接受了 3 种最常植入的自膨式支架移植物（35 个 Talent、39 个 Excluder 和 29 个 Zenith）并且在我院进行了至少 3 个月影像学随访的患者进行本研究。所有直径均在计算机断层扫描时沿血流中心线垂直测量；基线数据来自术后首次扫描。支架移植物迁移距离从最下肾动脉到支架移植物的第一个支柱。基于内部和外部观察者误差测量，定义主动脉颈扩张的最小变化为 2mm。

结果

在平均 39.4 个月（范围 3-108.8）的随访期间，在 Talent 组中发现 10 名患者（28.6%，95%CI 14.6-46.3）存在肾下主动脉颈扩张（>2mm），在 Excluder 组中发现 4 名患者（10.3%，95%CI 2.9-24.2），在 Zenith 组中发现 9 名患者（31.0%，95%CI 15.3-50.8）（p=0.299）。在 23 名颈扩张患者中，有 7 名（31%）需要额外治疗。在 6 名患者（17.1%，95%CI 6.6-33.6）、8 名患者（20.5%，95%CI 9.3-36.5）和 5 名患者（17.2%，95%CI 5.8-35.8）中发现了肾上变化，分别（p=0.218）。在随访的 103 名患者中，有 2 名（1.9%）发生了支架移植物迁移>2mm。Talent 的总体内漏率为 37.1%，Excluder 为 30.8%，Zenith 为 37.9%（p>0.05）。由于 Talent 支架移植物迁移和持续的 I 型漏（Zenith），有 2 名患者转为开放修复。总体再介入率为 13.6%（13/103）。