Saha Prakash, Hughes John, Patel Ashish S, Donati Tommaso, Sallam Morad, Patel Sanjay D, Bell Rachel E, Katsanos Konstantinos, Modarai Bijan, Zayed Hany A
Department of Vascular Surgery, Guy's and St. Thomas' Hospitals, NHS Foundation Trust, King's Health Partners, 1st Floor North Wing, London, SE1 7EH, UK,
Cardiovasc Intervent Radiol. 2015 Aug;38(4):840-5. doi: 10.1007/s00270-014-1038-3. Epub 2014 Dec 24.
The purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.
A retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.
The median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93%, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).
EVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities.
本研究的目的是评估使用近端直径为36毫米或更大的支架型人工血管对颈部解剖结构不利的腹主动脉瘤进行血管腔内修复（EVAR）后的中期结果。
对2006年至2008年间接受择期EVAR且使用近端直径为36毫米或更大的支架型人工血管的27例患者进行回顾性研究。所有患者均行计算机断层血管造影（CTA）以进行手术规划，并使用三维CTA工作站对动脉瘤颈部进行详细评估。患者在术后3个月和12个月时接受CTA随访，此后每年进行双功超声检查。
动脉瘤的中位直径为7厘米，动脉瘤颈部的中位直径为31毫米。所有患者均使用库克Zenith支架型人工血管，近端直径为36毫米（n = 25）和40毫米（n = 2）。一期和辅助一期技术成功率分别为74%和93%。随访期为62至84个月，中位时间为72个月。15例患者在随访期间死亡。2例患者死于主动脉破裂，其余患者死于心脏病（n = 4）、胸部感染（n = 6）、癌症（n = 2）和肾衰竭（n = 1）。并发症包括I型内漏（n = 5）、肢体闭塞（n = 2）、肢体狭窄（n = 2）、肢体扭曲（n = 1）、动脉夹层（n = 1）、股股交叉移植血管闭塞（n = 1）和远端肢体附着不良（n = 1）。
在颈部解剖结构不利的情况下使用支架型人工血管进行EVAR有较高的并发症风险。该组患者的中期生存率较低，但主要是由于患者的合并症。
