São Paulo Vascular & Endovascular Institute (ICVE-SP), São Paulo, Brazil.
J Endovasc Ther. 2012 Dec;19(6):691-706. doi: 10.1583/JEVT-12-4023R.1.
To assess the safety and efficacy of the sandwich technique for complex aortic aneurysms.
Between October 2008 and March 2012, 78 patients (70 men; mean age 73.3 years) undergoing complex thoracic or abdominal endovascular aneurysm repairs were treated with the sandwich technique when the aneurysm features did not fulfill the requirements for standard endovascular techniques or total aortic arch replacement. Two thirds of the population was treated for aortoiliac aneurysm (52, 66.7%). There were 15 (19.2%) thoracoabdominal aneurysms, 6 (7.7%) isolated iliac artery aneurysms, 3 (3.8%) arch aneurysms, and 2 (2.6%) abdominal aortic aneurysm with non-diseased, short common iliac arteries bilaterally. Five (6.4%) symptomatic patients were submitted to endovascular repair in the urgent setting.
Technical success was 98.7%; one procedure was aborted when both renal arteries could not be cannulated. Over a mean 17-month follow-up (range 1-42), primary patency was high (96.7%) and mortality low (early: 5.1%, late: 1.3%). Overall, only 4 (5.1%) type II endoleaks persisted: 3 early with no sac increase and 1 late with sac increase that was managed conservatively on patient demand (stable at 9 months). In all other aneurysms except the 3 in the arch, there was a 5-mm reduction in size achieved by the end of the second year of follow-up, though this was significant only in the aortoiliac aneurysm group (p<0.005).
The sandwich technique facilitates safe and effective aneurysm exclusion and target vessel revascularization in adverse anatomical scenarios, with sustained durability in midterm follow-up.
评估夹心技术治疗复杂主动脉瘤的安全性和有效性。
2008 年 10 月至 2012 年 3 月，78 例（70 例男性；平均年龄 73.3 岁）接受复杂胸腹主动脉腔内动脉瘤修复术的患者，当动脉瘤特征不符合标准腔内技术或全主动脉弓置换要求时，采用夹心技术治疗。其中 2/3的患者为主动脉-髂动脉瘤（52 例，66.7%）；15 例（19.2%）为胸腹主动脉瘤，6 例（7.7%）为孤立髂动脉瘤，3 例（3.8%）为弓部动脉瘤，2 例（2.6%）为双侧髂总动脉无病变、短的腹主动脉瘤。5 例（6.4%）有症状的患者在紧急情况下接受了腔内修复术。
技术成功率为 98.7%；有 1 例因双侧肾动脉无法插管而中止手术。平均 17 个月（1-42 个月）的随访中，一期通畅率高（96.7%），死亡率低（早期：5.1%，晚期：1.3%）。总的来说，只有 4 例（5.1%）出现 II 型内漏：3 例早期无囊袋增大，1 例晚期囊袋增大，根据患者需求行保守治疗（9 个月时稳定）。除了 3 例弓部动脉瘤外，所有其他动脉瘤在随访的第二年结束时都有 5mm 的缩小，尽管在主动脉-髂动脉瘤组中这一变化有统计学意义（p<0.005）。
夹心技术在不利的解剖学情况下，能安全有效地进行动脉瘤隔绝和靶血管血运重建，在中期随访中具有持久的耐用性。
