采用Ovation TriVascular覆膜支架系统，在局部麻醉下以主要经皮的方式进行血管内动脉瘤修复。
Endovascular aneurysm repair with the Ovation TriVascular Stent Graft System utilizing a predominantly percutaneous approach under local anaesthesia.
作者信息
Ioannou C V, Kontopodis N, Kehagias E, Papaioannou A, Kafetzakis A, Papadopoulos G, Pantidis D, Tsetis D
机构信息
1 Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University of Crete Medical School, Heraklion, Crete, Greece.
2 Interventional Radiology Unit, Radiology Department, University of Crete Medical School, Heraklion, Crete, Greece.
出版信息
Br J Radiol. 2015 Jul;88(1051):20140735. doi: 10.1259/bjr.20140735. Epub 2015 May 12.
OBJECTIVE
To present our experience with the Ovation Abdominal Stent Graft System (TriVascular Inc., Santa Rosa, CA) during endovascular aneurysm repair (EVAR) and compare results according to the type of anaesthesia.
METHODS
We conducted a single-centre retrospective study including patients who underwent EVAR using the Ovation endograft between May 2011 and July 2014. Outcome was evaluated regarding pre-, peri- and immediate postoperative and follow-up measures. Overall results are reported, while additional analysis was performed to compare the outcome between groups of patients undertaking either local or regional/general anaesthesia (LA vs RGA).
RESULTS
66 patients were included. Median follow-up was 13 months (range, 1-39 months). Median age was 72 years and median abdominal aortic aneurysm diameter was 58 mm (range, 54-100 mm). Technical success was 63 (95%), while there were 2 (3%) conversions to open surgery. A total percutaneous approach was used in 50/66 (76%) cases. Overall, 9/66 (14%) subjects suffered from any kind of morbidity. Median hospitalization was 3 days (range, 1-16 days). Immediate and midterm mortality rate was 0%. No endoleak Type I, III, IV or stent migration was observed. There were 8 (13%) Type II endoleaks. Overall, additional endovascular procedures were required in 6 (9%), while surgery was performed in 4 (6%) patients. 44 (67%) patients underwent LA and 22 (23%) RGA. Differences between groups were significant for procedural time (85 vs 107 min; p < 0.001), percutaneous access (91% vs 45%; p < 0.001) and systematic complications (2.3% vs 14%; p = 0.05).
CONCLUSION
EVAR with the use of the Ovation endograft shows promising short-term and midterm results regarding safety and effectiveness. Completion of the procedures under LA using a total percutaneous approach seems advantageous and may be used in routine practice.
ADVANCES IN KNOWLEDGE
The Ovation Abdominal Stent Graft System is an ultra-low profile stent graft system that allows percutaneous deployment for EVAR and offers excellent overall efficacy and safety. Totally percutaneous EVAR under LA seems advantageous and may be used as a routine with this specific endograft.
目的
介绍我们在使用Ovation腹主动脉覆膜支架系统（TriVascular公司，加利福尼亚州圣罗莎市）进行血管腔内动脉瘤修复术（EVAR）时的经验，并根据麻醉类型比较结果。
方法
我们进行了一项单中心回顾性研究，纳入了2011年5月至2014年7月期间使用Ovation腔内移植物进行EVAR的患者。对术前、术中和术后即刻以及随访指标进行结果评估。报告总体结果，同时进行额外分析以比较接受局部或区域/全身麻醉（LA vs RGA）的患者组之间的结果。
结果
纳入66例患者。中位随访时间为13个月（范围1 - 39个月）。中位年龄为72岁，腹主动脉瘤中位直径为58mm（范围54 - 100mm）。技术成功率为63例（95%），2例（3%）转为开放手术。50/66（76%）例采用完全经皮入路。总体而言，9/66（14%）的患者出现任何类型的并发症。中位住院时间为3天（范围1 - 16天）。即刻和中期死亡率为0%。未观察到I型、III型、IV型内漏或支架移位。有8例（13%）II型内漏。总体而言，6例（9%）需要额外的血管腔内操作，4例（6%）患者接受了手术。44例（67%）患者接受LA，22例（23%）接受RGA。两组在手术时间（85 vs 107分钟；p < 0.001）、经皮入路（91% vs 45%；p < 0.001）和系统性并发症（2.3% vs 14%；p = 0.05）方面差异显著。
结论
使用Ovation腔内移植物进行EVAR在安全性和有效性方面显示出良好的短期和中期结果。在LA下采用完全经皮入路完成手术似乎具有优势，可用于常规实践。
知识进展
Ovation腹主动脉覆膜支架系统是一种超低调的覆膜支架系统，允许经皮植入用于EVAR，具有出色的总体疗效和安全性。在LA下完全经皮EVAR似乎具有优势，可作为使用这种特定腔内移植物的常规方法。
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