Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash 98104, USA.
J Vasc Surg. 2012 Sep;56(3):601-7. doi: 10.1016/j.jvs.2012.02.011. Epub 2012 May 2.
To determine if a physician-modified endovascular graft (PMEG) is a safe and effective method of treating juxtarenal aortic aneurysms in patients considered to be unsuitable for open surgical repair.
A retrospective, nonrandomized, single institution evaluation of the safety and efficacy of physician modification of a currently Food and Drug Administration-approved device (Zenith Flex; Cook Inc, Bloomington, Ind) to preserve branch vessels when used in the treatment of patients with elective, symptomatic, or ruptured juxtarenal aortic aneurysms.
Forty-seven consecutive patients underwent fenestrated endovascular repair using PMEG over a 3-year period. Thirty-eight patients (80%) were symptomatic or had rapid aneurysm expansion. Eighty-five percent of patients were American Society of Anesthesiologist category III or IV. Eight-two fenestrations were created for 58 renal arteries, 16 superior mesenteric arteries, three celiac arteries, and the rest accessory vessels. Mean follow-up was 607 days, with a range of 425 to 1460 days. Mean contrast usage and fluoro time were 98 mL and 48 minutes. Technical success rate was 98%, and freedom from aneurysm-related death was 98%. There were six complications (13%). Three (6%) were access related, and three (6%) were procedure related and included one stroke, one case of renal failure, and one branch artery dissection. On follow-up, six patients (13%) had endoleak. There was one type 1 endoleak and five type 2 endoleaks. In-hospital and 30-day mortality was 2%, with one patient expiring due to aspiration on the ward after successful endovascular repair. Two patients died during follow-up; one at 58 days due to cessation of dialysis and one at 485 days due to stent graft migration and occlusion of the superior mesenteric artery. There were two deaths in the first year, one in the second year, and zero in the most recent year of experience. One patient with endoleak (2%) had aneurysm sac expansion at 1 year requiring secondary intervention.
PMEG is a safe and effective alternative for treating patients with juxtarenal aneurysms who have no other alternatives for repair. Longer-term follow-up is needed to assess the durability of repair and potential for device-related complications.
确定医生改良的血管内移植物（PMEG）是否是治疗不适合开放手术修复的肾周主动脉瘤患者的安全有效的方法。
回顾性、非随机、单中心评估医生对目前经食品和药物管理局批准的设备（Zenith Flex；Cook Inc，印第安纳州布鲁明顿）进行改良以保留分支血管的安全性和有效性，该设备用于治疗择期、有症状或破裂的肾周主动脉瘤患者。
在 3 年期间，连续 47 例患者接受了 PMEG 开窗血管内修复。38 例（80%）有症状或动脉瘤快速扩张。85%的患者为美国麻醉师协会（ASA）分类 III 或 IV 级。82 个开窗用于 58 个肾动脉、16 个肠系膜上动脉、3 个腹腔动脉和其他辅助血管。平均随访时间为 607 天，范围为 425 至 1460 天。平均造影剂用量和透视时间分别为 98ml 和 48 分钟。技术成功率为 98%，与动脉瘤相关的死亡率为 98%。有 6 例并发症（13%）。其中 3 例（6%）为入路相关，3 例（6%）为手术相关，包括 1 例中风、1 例肾衰竭和 1 例分支动脉夹层。随访时，6 例（13%）患者发生内漏。其中 1 例为 1 型内漏，5 例为 2 型内漏。住院期间和 30 天死亡率为 2%，1 例患者在血管内修复成功后因病房内吸入而死亡。2 例患者在随访期间死亡；1 例在 58 天因停止透析，1 例在 485 天因支架移植物迁移和肠系膜上动脉闭塞。在最近的一年经验中，第一年有 2 例死亡，第二年有 1 例死亡，第三年没有死亡。1 例有内漏（2%）的患者在 1 年内出现动脉瘤囊扩张，需要再次介入治疗。
PMEG 是治疗没有其他修复选择的肾周动脉瘤患者的安全有效的替代方法。需要进行更长时间的随访以评估修复的耐久性和器械相关并发症的潜在风险。
