Vascular Center, Hôpital Cardiologique, Lille University Hospital, France.
Eur J Vasc Endovasc Surg. 2013 Oct;46(4):418-23. doi: 10.1016/j.ejvs.2013.07.018. Epub 2013 Aug 22.
To evaluate the influence of planning endovascular aneurysm repair (EVAR) with a three-dimensional (3D) workstation on early and midterm outcomes.
All patients undergoing infrarenal EVAR performed between 2006 and 2009 at our institution were included in the current study. Prior to 2008 (group 1), endograft sizing was performed by interrogation of computed tomography angiography axial images. After 2008 (group 2), endograft sizing was routinely performed using a 3D workstation (Aquarius, Terarecon), allowing for multiplanar reconstruction and centerline analysis. Pre-, peri-, postoperative, and follow-up data were prospectively entered in an electronic database. All postoperative complications and subsequent secondary interventions depicted during the 2-year period following EVAR were compared. Secondary intervention and mortality rates were defined at 2 years and compared. Freedom from secondary intervention and overall survival rates were calculated using the Kaplan-Meier method during follow-up and compared by log-rank test.
A total of 295 patients (149 patients in group 1 and 146 patients in group 2) were included. All patients had completed a minimum of 2 years of follow-up. During this 2-year period following EVAR, the type 1 endoleak rate was 8.7% in group 1 and 1.4% in group 2 (p = .004) respectively. Secondary intervention rates related to type 1 endoleak was 5.4% in group 1 and 0 in group 2 (p < .001). No difference was observed regarding all-cause mortality, aneurysm-related death, and freedom from secondary intervention rates during follow-up.
The routine use of 3D workstations for EVAR planning significantly reduces the rate of type 1 endoleaks and, therefore, the rate of related secondary interventions.
评估使用三维（3D）工作站规划血管内动脉瘤修复术（EVAR）对早期和中期结果的影响。
本研究纳入了 2006 年至 2009 年期间在我院行腹主动脉下段 EVAR 的所有患者。2008 年之前（组 1），通过询问 CT 血管造影轴位图像进行移植物大小测量。2008 年之后（组 2），使用 3D 工作站（Aquarius，Terarecon）常规进行移植物大小测量，允许进行多平面重建和中心线分析。术前、围手术期和术后以及随访数据被前瞻性地输入电子数据库。比较 EVAR 后 2 年内所有术后并发症和随后的二次干预。在 2 年时定义二次干预和死亡率，并进行比较。在随访期间，使用 Kaplan-Meier 方法计算无二次干预和总生存率，并通过对数秩检验进行比较。
共纳入 295 例患者（组 1 149 例，组 2 146 例）。所有患者均完成了至少 2 年的随访。在 EVAR 后 2 年内，组 1 的 1 型内漏发生率为 8.7%，组 2 为 1.4%（p =.004）。组 1 与 1 型内漏相关的二次干预率为 5.4%，组 2 为 0（p <.001）。在随访期间，全因死亡率、与动脉瘤相关的死亡率和无二次干预率方面没有差异。
EVAR 规划中常规使用 3D 工作站可显著降低 1 型内漏的发生率，从而降低相关二次干预的发生率。
