Petronelli Sergio, Zurlo Maria Teresa, Giambersio Silvia, Danieli Lucia, Occhipinti Mariaelena
Unità Operativa Semplice dipartimentale di Radiologia Interventistica, Ente Ecclesiastico Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, BA, Italy,
Radiol Med. 2014 Nov;119(11):835-41. doi: 10.1007/s11547-014-0399-7. Epub 2014 Apr 4.
This study evaluated the feasibility and safety of percutaneous endovascular aneurysm repair (P-EVAR) in an "unselected" population of patients using Prostar XL closure device, comparing our results with the literature data reported for open EVAR (O-EVAR) and P-EVAR in selected populations.
We prospectively enrolled 200 patients with abdominal aortic aneurysms to be treated with the P-EVAR procedure, without any selection criteria. Four hundred percutaneous femoral accesses using the Prostar XL closure device were performed. The early follow-up protocol consisted of a Doppler ultrasound (US) examination. Later evaluations were performed with US and computed tomography.
Technical success was achieved in all percutaneous accesses (100 %). Ten early complications related to access site were recorded (10/400; 2.5 %): four pseudoaneurysms and six cases of lower limb ischaemia. Five of ten complications occurred in patients presenting calcification of the common femoral arteries, whereas 4/10 were in patients with "complex" groin anatomy. Eight of ten complications occurred at the access site of the main body of the prosthesis using a sheath size >20 Fr.
Percutaneous endovascular aneurysm repair in "unselected" patients is safe and efficient, with a very low risk of access-related complications, comparable to P-EVAR in selected populations and to the best O-EVAR series.
本研究评估了在“未选择”的患者群体中使用Prostar XL闭合装置进行经皮血管腔内动脉瘤修复术（P-EVAR）的可行性和安全性，并将我们的结果与已报道的在选择的患者群体中进行开放血管腔内动脉瘤修复术（O-EVAR）和P-EVAR的文献数据进行比较。
我们前瞻性纳入了200例将接受P-EVAR手术治疗的腹主动脉瘤患者，没有任何选择标准。使用Prostar XL闭合装置进行了400次经皮股动脉穿刺。早期随访方案包括多普勒超声（US）检查。后期评估采用US和计算机断层扫描。
所有经皮穿刺均获得技术成功（100%）。记录到10例与穿刺部位相关的早期并发症（10/400；2.5%）：4例假性动脉瘤和6例下肢缺血。10例并发症中有5例发生在股总动脉钙化的患者中，而4/10发生在腹股沟解剖结构“复杂”的患者中。10例并发症中有8例发生在使用鞘管尺寸>20 Fr的假体主体穿刺部位。
在“未选择”的患者中进行经皮血管腔内动脉瘤修复术是安全有效的，与选择的患者群体中的P-EVAR以及最佳的O-EVAR系列相比，与穿刺相关的并发症风险非常低。
