Imperial Vascular Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
Imperial Vascular Unit, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
J Vasc Surg. 2014 Mar;59(3):615-22. doi: 10.1016/j.jvs.2013.10.038. Epub 2013 Dec 15.
OBJECTIVE: Fenestrated stent grafting has become increasingly popular as a means to manage complex aortic pathology, including juxta- and pararenal aneurysms. The design of a recently developed custom-made fenestrated stent graft, in theory, confers advantages when managing anatomically challenging aortic morphology. This study evaluated its feasibility in anatomically challenging scenarios. METHODS: Over a 12-month period, 20 patients received fenestrated stent grafts. Among those, 13 patients with juxtarenal or type IV thoracoabdominal aortic aneurysms underwent endovascular repair with the novel fenestrated stent graft at a single UK institution. Data on aneurysm morphology and immediate and short-term results were collected prospectively. RESULTS: The mean aneurysmal sac size was 7.3 cm (range, 5.5-10.0 cm). The mean infrarenal neck length was 4.4 mm (range, 0-9 mm), and in three cases was lined by a pre-existing infrarenal stent graft. Nine cases had an infrarenal neck angulation of 60(°) or more in either the anteroposterior or coronal planes. Five cases had ≥50% thrombus at the proximal landing zone. A total of 35 target vessels were cannulated, of which six right renal and four left renal arteries were angulated ≥120(°). Two-thirds of cannulated celiac trunks were angulated ≥120(°), and one cannulated superior mesenteric artery was angulated ≥ 140(°). Seven of the cannulated targets were stenosed more than 60%. One patient had two right renal arteries arising 3 mm from each other. Four right and four left common iliac arteries were angulated ≥90(°) in relation to the infrarenal aorta. Technical success was 100%. Median time from date of procedure to most recent follow-up with computed tomography scanning was 33 weeks. There was no type I or III endoleak. One type II endoleak was observed at the time of most recent computed tomography scanning and treated expectantly. There was a single incident of left renal artery occlusion. One patient required repair of a brachial artery, fasciotomies, and temporary haemofiltration. One patient died from ischemic heart disease 77 weeks after the procedure. CONCLUSIONS: The use of the novel fenestrated stent graft system in patients with hostile aortic aneurysmal morphology is feasible with acceptable short-term outcomes.
目的：开窗支架移植物已成为治疗复杂主动脉病变的一种越来越受欢迎的方法，包括近肾和肾周动脉瘤。最近开发的定制开窗支架移植物的设计理论上在处理解剖上具有挑战性的主动脉形态方面具有优势。本研究评估了其在解剖学上具有挑战性的情况下的可行性。
方法：在 12 个月的时间内，20 名患者接受了开窗支架移植物治疗。其中，13 名患有近肾或 IV 型胸腹主动脉瘤的患者在英国的一家单一机构接受了新型开窗支架移植物的血管内修复。前瞻性收集了关于动脉瘤形态以及即刻和短期结果的数据。
结果：平均动脉瘤囊大小为 7.3cm（范围为 5.5-10.0cm）。肾下颈长度平均为 4.4mm（范围为 0-9mm），在 3 例中被预先存在的肾下支架移植物覆盖。9 例在前后或冠状平面上的肾下颈角度为 60°或更大。5 例近端着陆区有≥50%的血栓形成。总共穿刺了 35 个靶血管，其中 6 个右肾和 4 个左肾动脉角度为≥120°。三分之二穿刺的腹腔干角度≥120°，一个穿刺的肠系膜上动脉角度≥140°。7 个穿刺的目标血管狭窄超过 60%。1 例患者有两个右肾动脉彼此相距 3mm。4 个右髂总动脉和 4 个左髂总动脉与肾下主动脉的夹角≥90°。技术成功率为 100%。从手术日期到最近一次 CT 扫描的中位随访时间为 33 周。没有 I 型或 III 型内漏。最近一次 CT 扫描时观察到 1 例 II 型内漏，期待治疗。有 1 例左肾动脉闭塞。1 例患者需要修复肱动脉、筋膜切开术和临时血液滤过。1 例患者在手术后 77 周死于缺血性心脏病。
结论：在具有敌对主动脉瘤形态的患者中使用新型开窗支架移植物系统是可行的，具有可接受的短期结果。
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