Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany.
J Endovasc Ther. 2011 Apr;18(2):146-53. doi: 10.1583/10-3274.1.
To investigate the secondary procedures in patients with previous endovascular aortic repair by fenestrated or branched stent-grafts for aneurysms involving the renal and visceral vessels.
Between January 2001 and May 2010, 107 consecutive high-risk patients (97 men; mean age 73 years, range 50-86) with aortic aneurysms involving the renal and visceral arteries were treated with endovascular techniques. A custom-made Zenith graft was used in all patients. All secondary graft-related procedures performed in the perioperative period and during follow-up were analyzed. Estimates of survival, freedom from migration/type I endoleak, and freedom from any device-related secondary procedures were assessed with Kaplan-Meier analyses.
The 30-day mortality rate was 1.9%. During follow-up (mean 25 months, range 1-94), 34 secondary procedures were performed in 28 (26.2%) patients for 6 (17.6%) limb graft stenoses/thromboses (5.6% of 107 cases), 8 (23.5%) in-stent visceral vessel stenoses/occlusions (7.5% of 107 cases), 8 (23.5%) migrations/type I endoleaks with/without visceral stent fractures (7.5% of 107 cases), and 12 (35.3%) type III endoleaks (9.3% of 107 cases). The mean interval between the primary and secondary procedures was 12.9 months (range 1-68). In 26 (76.5%) of 34 cases, a secondary endovascular procedure was performed; in the remaining 8 (23.5%) cases, the complication was treated surgically. The secondary procedure was unsuccessful in 9 cases of visceral vessel compromise (failure to cannulation, stent fracture/migration, in-stent stenosis/occlusion). Estimated 3-year survival was 77%, while the 3-year rate for freedom from any device-related secondary procedure was 75.5%.
The incidence of early and late complications requiring a secondary procedure after treatment with fenestrated or branched devices was not negligible. Endoleak type III represented the most common cause for reintervention during follow-up. Secondary procedures performed for visceral vessel compromise had high rates of treatment failure. Accurate preoperative planning, the advent of new materials/techniques, and strict follow-up could be the key factors to improving the results of fenestrated or branched stent-graft interventions and to reduce the rate of secondary procedures.
研究累及肾及内脏血管的主动脉瘤患者行腔内修复术（使用开窗或分支支架移植物）后行二期手术的情况。
2001 年 1 月至 2010 年 5 月，107 例高危患者（97 例男性；平均年龄 73 岁，范围 50-86 岁）行腔内技术治疗累及肾及内脏血管的主动脉瘤。所有患者均使用定制的 Zenith 移植物。分析围手术期及随访期间所有与移植物相关的二期手术。采用 Kaplan-Meier 分析法评估生存、无移植物迁移/1 型内漏及无任何器械相关二期手术的情况。
30 天死亡率为 1.9%。在随访期间（平均 25 个月，范围 1-94 个月），28 例（26.2%）患者因 6 例（17.6%）肢体移植物狭窄/血栓形成（107 例中的 5.6%）、8 例（23.5%）支架内内脏血管狭窄/闭塞（107 例中的 7.5%）、8 例（23.5%）移植物迁移/1 型内漏伴/不伴内脏支架断裂（107 例中的 7.5%）和 12 例（35.3%）3 型内漏（107 例中的 9.3%）行 34 例二期手术。一期和二期手术的平均间隔时间为 12.9 个月（范围 1-68 个月）。34 例中 26 例（76.5%）行二期腔内治疗，8 例（23.5%）行外科治疗。内脏血管受损的 9 例（未能进行血管内治疗、支架断裂/迁移、支架内狭窄/闭塞）二期手术治疗失败。3 年生存率估计为 77%，3 年无任何器械相关二期手术的发生率为 75.5%。
使用开窗或分支移植物治疗后需要二期手术的早期和晚期并发症的发生率并不低。随访期间，3 型内漏是再次介入治疗最常见的原因。针对内脏血管受损行二期手术的治疗失败率较高。准确的术前规划、新材料/技术的出现以及严格的随访可能是改善开窗或分支支架移植物介入治疗效果和降低二期手术发生率的关键因素。
