St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK.
J Endovasc Ther. 2012 Aug;19(4):528-35. doi: 10.1583/JEVT-11-3807R.1.
To evaluate the outcomes of endografts designed with renal fenestrations alone vs. more complex designs that accommodate mesenteric arteries in a consecutive series of patients with pararenal aortic aneurysms undergoing endovascular aneurysm repair (EVAR).
A retrospective review of data prospectively collected over a 5-year period identified 42 consecutive patients (39 men; mean age 70±7 years) who had undergone fenestrated repair of 3 type IV thoracoabdominal aortic aneurysms (TAAA), 6 suprarenal aneurysms requiring at least 1 renal artery reimplantation, and 33 juxtarenal aneurysms with an infrarenal aortic neck <5 mm long. Operative variables and patient outcomes for complex fenestrated EVAR cases (n = 17) using endografts involving the renal, superior mesenteric, and/or celiac arteries were compared with fenestrated stent-grafts incorporating the renal arteries alone (n = 25). Major morbidity/mortality included death, myocardial infarction (MI), renal failure requiring dialysis, paraplegia, and bowel ischemia.
Of the 95 intended target vessels, 93 (98%) were successfully cannulated and stented (mean 2.2 covered stents per patient). The 30-day mortality was 7% (n = 3), the paraplegia rate was 2% (n = 1), and MI rate was 5% (n = 2). One patient required dialysis for 3 months. Two bridging stent-grafts occluded: one immediately and another at 8 months. Complex fenestrated EVARs were associated with higher risk of major morbidity and mortality (4, 24%) compared to endografts involving the renal arteries alone (2, 8%), but this did not reach statistical significance (p = 0.20). Operation time (mean 205±50 vs. 174±48 minutes, p = 0.07), follow-up duration (mean 8.1±11 vs. 13±17 months, p = 0.29), and reintervention rates (18% vs. 24%, p = 0.72), respectively, were not significantly different between groups.
In carefully selected patients with pararenal aneurysms, the inclusion of mesenteric arteries in the fenestrated graft design did not influence outcomes compared to fenestrated EVARs involving the renal arteries alone.
评估单纯肾开窗型和更复杂型内脏动脉开窗支架移植物在腔内修复治疗肾周腹主动脉瘤患者中的应用效果，该研究纳入了连续的一系列患者。
回顾性分析前瞻性收集的 5 年内数据，共纳入 42 例接受腔内修复术治疗的肾周腹主动脉瘤患者，其中 3 型胸腹主动脉瘤（TAAA）3 例，肾上型动脉瘤 6 例，需要至少 1 个肾动脉再植入，肾下型动脉瘤 33 例，肾下主动脉颈长度＜5mm。比较复杂开窗型腔内修复术（涉及肾动脉、肠系膜上动脉和/或腹腔动脉）和单纯肾动脉开窗支架移植物（仅涉及肾动脉）的手术变量和患者结局。主要不良事件包括死亡、心肌梗死（MI）、需要透析的肾功能衰竭、截瘫和肠缺血。
95 个目标血管中，93 个（98%）成功穿刺并置管（平均每个患者使用 2.2 个覆膜支架）。30 天死亡率为 7%（n=3），截瘫率为 2%（n=1），MI 率为 5%（n=2）。1 例患者需要透析 3 个月。2 个桥接支架移植物闭塞：1 例立即闭塞，1 例 8 个月后闭塞。与单纯肾动脉开窗支架移植物（2 例，8%）相比，复杂开窗型腔内修复术的主要不良事件发生率更高（4 例，24%），但差异无统计学意义（p=0.20）。手术时间（平均 205±50 比 174±48 分钟，p=0.07）、随访时间（平均 8.1±11 比 13±17 个月，p=0.29）和再干预率（18%比 24%，p=0.72）分别在两组间无显著差异。
在精心选择的肾周动脉瘤患者中，与单纯肾动脉开窗支架移植物相比，在开窗支架移植物设计中纳入肠系膜动脉并不影响预后。
