Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Shinchon-dong, Seodaemun-gu, Seoul, Republic of Korea.
J Vasc Interv Radiol. 2012 Aug;23(8):1065-9. doi: 10.1016/j.jvir.2012.04.014. Epub 2012 Jun 13.
To evaluate the effectiveness of the coupling stent-graft technique and outcomes on contrast-enhanced computed tomography (CT).
All patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) between 2007 and 2010 at a single institution were retrospectively analyzed. Of the 161 cases, 19 patients who had coupling stent-grafting because of AAA proximal neck angulation greater than 60°, conical neck, or iliac tortuosity were included. Patient age ranged from 62 to 87 years (mean, 73.3 y). Mean follow-up was 18.7 months (range, 1-36 mo). The coupling stent-graft technique was defined by the use of suprarenal fixation device main bodies (Zenith or Talent) with one or more EXCLUDER limbs to adapt tortuous and angulated iliac arteries. Pretreatment contrast-enhanced CT was analyzed based on three-dimensional and multiplanar reformatted images. Follow-up contrast-enhanced CT was also analyzed.
Mean aneurysm diameter was 68.9 mm ± 14.0, neck length was 32.7 mm ± 15.1, and neck angulation was 68.9° ± 11.5. Conical neck shapes were present in four patients (21.1%) and ruptured AAAs were present in two (10.5%). Among 38 iliac arteries, the mean iliac artery tortuosity index was 1.52 ± 0.27 and iliac angle was 106.8° ± 18.1. Three patients (15.8%) underwent repeat intervention: placement of a balloon-expandable stent in the proximal neck for type I endoleak (n = 1), endovascular embolization for proximal type I endoleak (n = 1), and percutaneous approach following endovascular embolization for type II endoleak (n = 1). No type III endoleak, limb occlusion, limb kinking, or stent-graft migration developed.
The coupling stent-graft technique is technically feasible, with acceptable midterm outcomes in EVAR of AAA in patients with unfavorable neck and iliac anatomies.
评估在增强型计算机断层扫描（CT）中使用杂交支架-移植物技术的效果和结果。
回顾性分析了 2007 年至 2010 年在一家机构接受腹主动脉瘤（AAA）血管内修复（EVAR）的所有患者。在 161 例患者中，有 19 例因 AAA 近端颈部角度大于 60°、锥形颈部或髂动脉扭曲而行杂交支架-移植物治疗。患者年龄 62 至 87 岁（平均 73.3 岁）。平均随访时间为 18.7 个月（范围，1-36 个月）。杂交支架-移植物技术是指使用肾上固定装置主体（Zenith 或 Talent）与一个或多个 EXCLUDER 分支来适应扭曲和成角的髂动脉。根据三维和多平面重建图像分析预处理增强 CT。还分析了随访增强 CT。
平均动脉瘤直径为 68.9mm±14.0，颈部长度为 32.7mm±15.1，颈部角度为 68.9°±11.5。4 例（21.1%）患者存在锥形颈部形态，2 例（10.5%）患者存在破裂的 AAA。38 条髂动脉中，平均髂动脉扭曲指数为 1.52±0.27，髂动脉角度为 106.8°±18.1。3 例（15.8%）患者接受了重复干预：1 例近端颈部行球囊扩张支架置入治疗 I 型内漏，1 例近端行血管内栓塞治疗 I 型内漏，1 例血管内栓塞后经皮入路治疗 II 型内漏。无 III 型内漏、分支闭塞、分支扭结或支架-移植物移位。
在具有不利颈部和髂部解剖结构的 AAA 的 EVAR 中，杂交支架-移植物技术具有一定的技术可行性，中期结果可接受。
