使用Anaconda主动脉腔内移植物进行血管内腹主动脉瘤修复的结果。
Results of the endovascular abdominal aortic aneurysm repair using the Anaconda aortic endograft.
作者信息
Freyrie Antonio, Gallitto Enrico, Gargiulo Mauro, Faggioli Gianluca, Massoni Claudio Bianchini, Mascoli Chiara, Pini Rodolfo, Stella Andrea
机构信息
Vascular Surgery, University of Bologna, Bologna, Italy.
Vascular Surgery, University of Bologna, Bologna, Italy.
出版信息
J Vasc Surg. 2014 Nov;60(5):1132-1139. doi: 10.1016/j.jvs.2014.04.073. Epub 2014 Oct 23.
OBJECTIVE
The objective of this study was to evaluate early and late results of the Anaconda aortic endograft (Vascutek, Terumo, Inchinnan, Scotland) in a single-center experience.
METHODS
From September 2005 to March 2012, patients underwent endovascular aortic repair for abdominal aortic aneurysm (AAA) with Anaconda endograft were prospectively enrolled in a dedicated database. Demographic and aortoiliac morphological data were considered. Preoperative planning was based on thoracoabdominal and pelvic computed tomography angiography. Follow-up included duplex ultrasound or computed tomography angiography at 1, 6, and 12 months and yearly thereafter. Primary end points were technical success, early and late primary and primary assisted clinical success (CS), overall and AAA-related survival and freedom from reinterventions. Secondary end points were endoleaks (ELs), steno-obstructive iliac leg complications, and AAA shrinkage.
RESULTS
An Anaconda endograft was implanted in 177 patients (male 94%; mean age, 73.3 ± 7.4 years; American Society of Anesthesiologists class III-IV, 85% and 9%, respectively). The mean AAA diameter, neck length, and diameter were 55 ± 9.7 mm, 26.7 ± 10 mm, and 23 ± 2.3 mm, respectively. There was an aortic neck angle >60° in 44 (25%) patients. Iliac angles >90° were observed in 152 (43%) iliac axes. Technical success was 98.9%. Early CS was 96%. Mean follow-up was 33 ± 23.3 months. Late assisted CS was 97.7%. Survival at 12, 24, and 36 months was 96.4%, 89%, and 86.2%, respectively. There was only one case of late AAA-related mortality. Freedom from reintervention was 94%, 92%, and 85% at 12, 24, and 36 months, respectively. Three (1.7%) conversions occurred during follow-up. There were 14.1% ELs at the completion angiography (EL Ia, 1.1%; EL II, 13%). Late ELs were 20.2% (EL Ia, 1.1%; EL Ib, 2.2%; EL II, 16.9%). Iliac leg complications occurred in 5.6% of the cases. An AAA shrinkage >5 mm was observed in 130 (73.4%) patients. In 7 (4%) cases there was an AAA enlargement >5 mm.
CONCLUSIONS
Data in our series demonstrate that the Anaconda endograft has good early and late results in the treatment of AAAs.
目的
本研究的目的是评估在单中心经验中，安那康达主动脉内移植物（Vascutek公司，泰尔茂公司，苏格兰因琴南）的早期和晚期结果。
方法
从2005年9月至2012年3月，前瞻性地将接受安那康达内移植物进行腹主动脉瘤（AAA）血管内修复的患者纳入一个专用数据库。记录人口统计学和腹主动脉-髂动脉形态学数据。术前规划基于胸腹部和盆腔计算机断层扫描血管造影。随访包括在1、6和12个月以及此后每年进行的双功超声或计算机断层扫描血管造影。主要终点是技术成功、早期和晚期主要及主要辅助临床成功（CS）、总体和AAA相关生存率以及免于再次干预。次要终点是内漏（ELs）、髂动脉狭窄-阻塞性并发症和AAA缩小。
结果
177例患者植入了安那康达内移植物（男性占94%；平均年龄73.3±7.4岁；美国麻醉医师协会分级III-IV级分别为85%和9%）。AAA的平均直径、颈部长度和直径分别为55±9.7mm、26.7±10mm和23±2.3mm。44例（25%）患者的主动脉颈部角度>60°。在152条（43%）髂动脉轴中观察到髂动脉角度>90°。技术成功率为98.9%。早期CS为96%。平均随访时间为33±23.3个月。晚期辅助CS为97.7%。12、24和36个月时的生存率分别为96.4%、89%和86.2%。仅1例为晚期AAA相关死亡。12、24和36个月时免于再次干预的比例分别为94%、92%和85%。随访期间发生了3例（1.7%）中转。造影完成时ELs发生率为14.1%（EL Ia，1.1%；EL II，13%）。晚期ELs发生率为20.2%（EL Ia，1.1%；EL Ib，2.2%；EL II，16.9%）。5.6%的病例发生了髂动脉并发症。130例（73.4%）患者观察到AAA缩小>5mm。7例（4%）患者的AAA增大>5mm。
结论
我们系列的数据表明，安那康达内移植物在治疗AAA方面具有良好的早期和晚期结果。
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