Sobocinski Jonathan, Briffa Florent, Holt Peter J, Martin Gonzalez Teresa, Spear Rafaëlle, Azzaoui Richard, Maurel Blandine, Haulon Stéphan
Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, Lille, France.
J Vasc Surg. 2015 Oct;62(4):841-7. doi: 10.1016/j.jvs.2015.04.452. Epub 2015 Aug 1.
Low-profile (LP) stent grafts are now commercially available in Europe for endovascular aortic aneurysm repair (EVAR). In this study the midterm outcomes and characteristics of patients treated with this last generation of stent grafts were compared with a cohort of patients treated with "standard-profile" (SP) stent grafts.
The current study enrolled all patients treated for elective EVAR by the SP Zenith Flex stent graft (Cook Medical, Bloomington, Ind) between March 2010 and November 2011 and patients treated for elective EVAR by the Zenith LP stent graft (Cook Medical) between November 2011 and March 2013. All patients had a follow-up >18 months. Preoperative computed tomography angiograms were analyzed on a dedicated three-dimensional workstation. All data were prospectively collected in an electronic database and retrospectively analyzed. A comparative study was conducted.
The present study included 208 patients (107 SP and 101 LP). Patients' physiologic characteristics were similar in both groups. The iliac anatomy was considered "more challenging" in LP patients: respectively, 7% and 22% (P = .002) of SP and LP patients had bilateral external iliac diameter <7 mm; and 16% and 34% (P = .005) had a combination of an external iliac diameter <7 mm and an iliac tortuosity ratio index >1.5. No 30-day deaths were documented. The 24-month freedom from reintervention and overall survival rates after SP and LP were, respectively, 88% and 91% (P = .450) and 92% and 96% (P = .153). The 24-month rates for freedom from sac expansion and from limb occlusion were 96.4% and 98.7% (P = .320) and 92% and 95% (P = .293), respectively. One patient in each group presented with a type I endoleak during follow-up, and two LP patients presented with a type III endoleak (P = .235).
This study demonstrates that the last-generation LP stent grafts have favorable midterm outcomes similar to SP stent grafts despite being used to treat more patients with unfavorable iliac anatomy.
低外形（LP）支架型人工血管目前在欧洲已上市，用于血管腔内修复腹主动脉瘤（EVAR）。在本研究中，将接受这一代最新支架型人工血管治疗的患者的中期结果和特征与一组接受“标准外形”（SP）支架型人工血管治疗的患者进行了比较。
本研究纳入了2010年3月至2011年11月期间接受SP Zenith Flex支架型人工血管（库克医疗公司，印第安纳州布卢明顿）择期EVAR治疗的所有患者，以及2011年11月至2013年3月期间接受Zenith LP支架型人工血管（库克医疗公司）择期EVAR治疗的患者。所有患者的随访时间均>18个月。在专用的三维工作站上分析术前计算机断层扫描血管造影。所有数据均前瞻性收集于电子数据库中并进行回顾性分析。进行了一项对比研究。
本研究纳入了208例患者（107例SP和101例LP）。两组患者的生理特征相似。LP组患者的髂部解剖结构被认为“更具挑战性”：SP组和LP组分别有7%和22%（P = 0.002）的患者双侧髂外直径<7 mm；16%和34%（P = 0.005）的患者髂外直径<7 mm且髂部迂曲率指数>1.5。未记录到30天内死亡病例。SP组和LP组术后24个月无再干预生存率和总生存率分别为88%和91%（P = 0.450）以及92%和96%（P = 0.153）。术后24个月无瘤体增大生存率和无肢体闭塞生存率分别为96.4%和98.7%（P = 0.320）以及92%和95%（P = 0.293）。每组各有1例患者在随访期间出现I型内漏，2例LP组患者出现III型内漏（P = 0.235）。
本研究表明，尽管使用这一代最新LP支架型人工血管治疗的患者中髂部解剖结构不利的患者更多，但中期结果良好，与SP支架型人工血管相似。
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