Montelione Nunzio, Pecoraro Felice, Puippe Gilbert, Chaykovska Lyubov, Rancic Zoran, Pfammatter Thomas, Mayer Dieter, Amann-Vesti Beatrice, Husmann Marc J, Veith Frank J, Mangialardi Nicola, Lachat Mario
Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland Department of Surgery "P. Valdoni," Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland Vascular Surgery Unit, University of Palermo, AOUP "P. Giaccone," Palermo, Italy
J Endovasc Ther. 2015 Aug;22(4):568-74. doi: 10.1177/1526602815586972. Epub 2015 May 12.
To evaluate the midterm outcomes of chimney and/or periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR).
Between June 2002 and April 2014, 24 consecutive patients (mean age 73.9±9.2 years; 23 men) presenting a type I endoleak were addressed with CPGs to extend the proximal and/or distal landing zone and to maintain side branch perfusion. Indication for treatment was a type Ia endoleak in 23 (96%) patients and a type Ib endoleak in one. Median interval from the previous EVAR to endoleak treatment with CPGs was 52.2±48.9 months (range 0.2-179). All patients had proximal/distal landing zones precluding any standard endovascular reintervention. Measured outcomes included technical success and perioperative mortality and morbidity. Technical success was defined as a procedure completed as intended, with no secondary procedures within 30 days. Midterm outcomes included survival, CPG patency, endoleaks, and freedom from reintervention.
Technical success was 96%; a single patient required an additional procedure to seal a recurrent type Ia endoleak. Intraoperative revascularization of all 55 target vessels (2.3/patient) with CPGs was successful. One (4%) patient died within 30 days. Estimated survival at 12, 24, and 36 months was 83%; estimated CPG patency at the same intervals was 94%. Over a mean follow-up of 23.4±29 months, 6 (25%) reinterventions were performed; of these, 4 were secondary to type I endoleak. Aneurysm diameters reduced from 88.3±26 to 85.5±33 mm (p=0.49) over the mean follow-up.
The CPG technique is a safe and effective tool for treatment of type I endoleak after previous EVAR. The CPG technique is feasible even in nonelective patients, with excellent outcomes in terms of patency. Close imaging follow-up is warranted to rule out recurrent or de novo endoleaks.
评估烟囱和/或潜望镜移植物（CPG）用于既往接受过血管内动脉瘤修复术（EVAR）后出现I型内漏患者的中期疗效。
2002年6月至2014年4月期间，连续24例（平均年龄73.9±9.2岁；23例男性）出现I型内漏的患者接受了CPG治疗，以延长近端和/或远端锚定区并维持分支血管灌注。治疗指征为23例（96%）患者为Ia型内漏，1例为Ib型内漏。从既往EVAR至采用CPG治疗内漏的中位间隔时间为52.2±48.9个月（范围0.2 - 179个月）。所有患者的近端/远端锚定区均排除了任何标准的血管内再次干预。测量的结果包括技术成功率、围手术期死亡率和发病率。技术成功定义为按计划完成手术，30天内无需二次手术。中期疗效包括生存率、CPG通畅率、内漏情况以及无再次干预。
技术成功率为96%；1例患者需要额外手术来封堵复发性Ia型内漏。使用CPG对所有55条靶血管（平均每位患者2.3条）进行术中血管重建均获成功。1例（占4%）患者在30天内死亡。12、24和36个月时的估计生存率为83%；相同时间间隔的估计CPG通畅率为94%。在平均23.4±29个月的随访期间，进行了6次（占25%）再次干预；其中4次是继发于I型内漏。在平均随访期间，动脉瘤直径从88.3±26 mm减小至85.5±33 mm（p = 0.49）。
CPG技术是治疗既往EVAR术后I型内漏的一种安全有效的工具。即使对于非选择性患者，CPG技术也是可行的，在通畅率方面有出色的疗效。需要进行密切的影像学随访以排除复发性或新生内漏。
