Department of Vascular Surgery, St. Franziskus Hospital and Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany.
J Endovasc Ther. 2012 Dec;19(6):723-8. doi: 10.1583/JEVT-12-3952MR.1.
To compare short-term outcomes between fenestrated and chimney endografts for pararenal aortic pathologies.
An English-language literature search up to January 2012 found 129 articles evaluating the immediate outcomes of endovascular repair of degenerative juxta-/suprarenal aortic aneurysms, type I endoleaks, and para-anastomotic aneurysms using the chimney technique or fenestrated endografts. Data concerning thoracoabdominal aortic aneurysms, ruptured aneurysms, and reports with <5 cases were excluded (n=84). An additional 28 articles were excluded for insufficient data, leaving 17 articles for review: 5 dealing with chimney grafts in 123 patients with pararenal aortic pathologies and 12 presenting data on 660 [corrected] patients undergoing fenestrated stent-grafting. The composite endpoints were 30-day mortality, deterioration of renal function, new postoperative dialysis dependence, and endoleak rate.
Cumulative 30-day procedure-related mortality was 0.58% (95% CI 0.0% to 2.93%) for the chimney group (n=3) and 1.17% (95% CI 0.26% to 2.09%, p=0.645) for the f-EVAR group (n=9). In the f-EVAR group, 86 (9.67%; 95% CI 4.77% to 14.57%) patients suffered from postoperative renal impairment vs. 16 (12.43%) patients in the chimney group (95% CI 2.39% to 22.48%, p=0.628). In the chimney group, 4 (0.57%; 95% CI 0.0% to 2.94%) patients required persistent postoperative dialysis in contrast to the 1.33% (95% CI 0.29% to 2.37%, p=0.567) rate (n=9) in patients undergoing f-EVAR. There were also no significant differences recorded in the endoleak rate: 1.93% (95% CI 0.0% to 4.82%) of the chimney patients had a persistent type Ia endoleak vs. 2.06% (95% CI 0.69% to 3.43%) for the f-EVAR group (p=0.939). For type II endoleaks, the rates were 2.16% (95% CI 0.0% to 10.77%) for the chimney group vs. 6.88% (95% CI 1.92% to 11.83%) for the f-EVAR group (p=0.352). No patient in the chimney group had a type III endoleak, and the rate was low in the f-EVAR group (0.32%, 95% CI 0.0% to 0.91%, p=0.079).
No statistically significant differences were found between the two endovascular approaches for pararenal aortic pathologies in terms of 30-day mortality, renal impairment, or endoleak. These findings support the assumption that chimney grafts may be a reliable alternative in the treatment of pararenal aortic pathologies.
比较腔内修复治疗肾周主动脉病变中使用开窗和烟囱内支架的短期结果。
截至 2012 年 1 月，通过英文文献检索，共找到 129 篇评估使用烟囱技术或开窗内支架治疗退行性肾周/肾上腹主动脉瘤、I 型内漏和吻合口后动脉瘤的即时结果的文章。排除胸主动脉瘤、破裂性动脉瘤和报告例数<5 的文章（n=84）。另外排除 28 篇因数据不足的文章，共 17 篇文章进行综述：5 篇文章涉及 123 例肾周主动脉病变患者的烟囱移植物，12 篇文章报道 660 例[更正]接受开窗支架置入术的患者的数据。复合终点为 30 天死亡率、肾功能恶化、新术后透析依赖和内漏率。
烟囱组（n=3）30 天手术相关死亡率为 0.58%（95%CI 0.0%至 2.93%），f-EVAR 组（n=9）为 1.17%（95%CI 0.26%至 2.09%，p=0.645）。在 f-EVAR 组，86 例（9.67%；95%CI 4.77%至 14.57%）患者术后发生肾功能损害，而烟囱组为 16 例（12.43%；95%CI 2.39%至 22.48%，p=0.628）。在烟囱组中，4 例（0.57%；95%CI 0.0%至 2.94%）患者需要持续术后透析，而 f-EVAR 组中 9 例（1.33%；95%CI 0.29%至 2.37%，p=0.567）的比率则没有显著差异。内漏率也没有显著差异：烟囱组中有 1.93%（95%CI 0.0%至 4.82%）的患者存在持续的 Ia 型内漏，而 f-EVAR 组为 2.06%（95%CI 0.69%至 3.43%）（p=0.939）。对于 II 型内漏，烟囱组的发生率为 2.16%（95%CI 0.0%至 10.77%），f-EVAR 组为 6.88%（95%CI 1.92%至 11.83%）（p=0.352）。烟囱组无 III 型内漏，f-EVAR 组发生率较低（0.32%，95%CI 0.0%至 0.91%，p=0.079）。
在肾周主动脉病变的治疗中，两种腔内治疗方法在 30 天死亡率、肾功能损害或内漏方面没有统计学上的显著差异。这些发现支持这样一种假设，即烟囱移植物可能是治疗肾周主动脉病变的一种可靠替代方法。
