Grisafi Joseph L, Rahbar Rodeen, Nelms Justin, Detschelt Elizabeth L, Chess Bart A, Benckart Daniel H, Muluk Satish C
Department of Surgery, Division of Vascular Surgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
Ann Vasc Surg. 2011 Aug;25(6):729-34. doi: 10.1016/j.avsg.2011.02.028. Epub 2011 May 28.
The purpose of this study was to determine which proximal seal zone characteristics were predictive of early and late type Ia endoleak development after endovascular aortic aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysmal disease.
We evaluated 146 patients who underwent EVAR between January 2006 and March 2007. In the cohort, high-resolution computed tomography images of 100 (68.5%) patients were available, which showed detailed measurement of proximal neck parameters, including diameter, length, calcification, thrombus, suprarenal and infrarenal angles, and reverse taper morphology. Postprocessing of digital data sets was performed to obtain centerline-of-flow measurements. Relevant medical records and follow-up computed tomography scans were reviewed.
Mean age of the patients was 72.7 years, with 78% being male. Of these patients, 66% did not satisfy the instructions for use for the Zenith EVAR device, and 50% did not satisfy the instructions for use for the AneuRx device. Nine patients had intraoperative type Ia endoleaks. A 100% assisted primary technical success rate was achieved with the adjunctive use of angioplasty (n = 4), uncovered stent (n = 3), and extension cuff (n = 2) placement. There was a significant association between type Ia endoleak development and magnitude of the infrarenal angle (p < 0.01); however, other parameters were not significant. At follow-up (mean, 587 days), no patient had a type Ia endoleak, and there were no aneurysm-related deaths.
Our data indicate that infrarenal angle is related to intraoperative type Ia endoleak occurrence, but other factors often thought to be indicative of adverse neck anatomy are not significant predictors. Moreover, all type Ia endoleaks in this cohort were successfully eliminated intraoperatively, and durability was confirmed on postoperative surveillance. These data demonstrate that challenging neck anatomy is associated with the need for intraoperative endovascular adjuncts, and that effective and durable aneurysm exclusion should still be expected.
本研究的目的是确定哪些近端密封区特征可预测肾下腹主动脉瘤疾病血管内主动脉瘤修复术（EVAR）后早期和晚期 Ia 型内漏的发生。
我们评估了2006年1月至2007年3月期间接受EVAR的146例患者。在该队列中，有100例（68.5%）患者可获得高分辨率计算机断层扫描图像，这些图像显示了近端颈部参数的详细测量结果，包括直径、长度、钙化、血栓、肾上和肾下角度以及逆向锥度形态。对数字数据集进行后处理以获得血流中心线测量值。回顾了相关病历和随访计算机断层扫描。
患者的平均年龄为72.7岁，其中78%为男性。在这些患者中，66%不符合Zenith EVAR装置的使用说明，50%不符合AneuRx装置 的使用说明。9例患者术中出现Ia型内漏。通过辅助使用血管成形术（n = 4）、裸支架（n = 3）和延长袖套（n = 2）放置，实现了100%的辅助主要技术成功率。Ia型内漏发生与肾下角度大小之间存在显著关联（p < 0.01）；然而，其他参数并不显著。在随访（平均587天）时，没有患者出现Ia型内漏，也没有与动脉瘤相关的死亡。
我们的数据表明，肾下角度与术中Ia型内漏的发生有关，但其他通常被认为表明颈部解剖结构不良的因素并不是显著的预测指标。此外，该队列中的所有Ia型内漏均在术中成功消除，术后监测证实了其耐久性。这些数据表明，具有挑战性的颈部解剖结构与术中血管内辅助装置的需求相关，并且仍应期望实现有效且持久的动脉瘤排除。
