Bargay-Juan Pau, Gómez-Palonés Francisco Julián, Pepén-Moquete Luis Ariel, Plaza-Martínez Ángel, Zaragozá-García Jose Miguel, Morales-Gisbert Sara Mercedes
Servicio de Angiología, Cirugía Vascular y Endovascular, Hospital Universitario Doctor Peset, Valencia, España.
Servicio de Angiología, Cirugía Vascular y Endovascular, Hospital Universitario Doctor Peset, Valencia, España.
Ann Vasc Surg. 2016 May;33:187-93. doi: 10.1016/j.avsg.2015.09.030. Epub 2016 Mar 8.
In the endovascular treatment of abdominal aortic aneurysm (AAA) with short or absent infrarenal neck, the delay in the availability of fenestrated device and its high cost, have led to the manufacture of standardized models. Another option is the endografts with stents in parallel; however, regulated criteria for their use and long-term studies are lacking. The aim of this study was to assessed whether the AAA treated with fenestrated device or stents in parallel in our department, complied with the characteristics for the placement of the new endograft p-branch(®). Furthermore, the differences between the p-branch and the implanted prosthesis were analyzed.
Single-center and descriptive study of 41 aneurysms treated consecutively from 2008 to 2015. The anatomic characteristics analyzed were: relative distances between the visceral arteries, time position, diameter in the sealing area and number of fenestrations, and its compatibility with the p-branch.
The anatomic compatibility rate with the p-branch options was 73.2% (30 cases). Of the 11 incompatible cases, 6 were due to misalignment of the visceral branches, 2 due to the aortic neck diameter being greater, another because the femoral access was inappropriate, and 2 more due to the fenestration configuration. Of the 30 cases in which compatibility existed, in 12 (40%) the configuration used coincided with the p-branch. In 13 cases, the number of fenestrations was higher than those actually used, with 23 fenestrations carried out and 39 hypothetical fenestrations with the new endograft. In the 5 remaining cases, a fenestration for the celiac trunk was necessary to achieve an adequate seal.
The p-branch could meet the needs of three-quarters of the aortic anatomies of our series, with favorable expectations on cost and waiting time. However, in most cases either a higher number of fenestrations are needed for visceral arteries or the proximal seal was shorter than would be ideal.
在腹主动脉瘤（AAA）的血管内治疗中，当肾下颈部较短或缺失时，开窗装置供应延迟及其高成本促使了标准化模型的制造。另一种选择是带有平行支架的腔内移植物；然而，其使用的规范标准和长期研究尚缺乏。本研究的目的是评估在我们科室接受开窗装置或平行支架治疗的AAA是否符合新型腔内移植物p-branch(®)放置的特征。此外，还分析了p-branch与植入假体之间的差异。
对2008年至2015年连续治疗的41例动脉瘤进行单中心描述性研究。分析的解剖学特征包括：内脏动脉之间的相对距离、时间位置、密封区域的直径、开窗数量及其与p-branch的兼容性。
与p-branch选项的解剖学兼容率为73.2%（30例）。在11例不兼容的病例中，6例是由于内脏分支未对齐，2例是由于主动脉颈部直径较大，1例是由于股动脉入路不合适，另外2例是由于开窗配置。在存在兼容性的30例病例中，12例（40%）使用的配置与p-branch一致。在13例病例中，开窗数量高于实际使用数量，共进行了23次开窗，而新型腔内移植物假设需要39次开窗。在其余5例病例中，为了实现充分密封，需要为腹腔干进行一次开窗。
p-branch可以满足我们系列中四分之三主动脉解剖结构的需求，在成本和等待时间方面有良好预期。然而，在大多数情况下，要么内脏动脉需要更多的开窗，要么近端密封比理想情况短。
