标准肾上腺固定型腔内移植物治疗颈部长度≤10毫米的腹主动脉瘤的结果，该研究针对不适合开放修复和开窗型腔内移植物的高危患者。
Results of standard suprarenal fixation endografts for abdominal aortic aneurysms with neck length ≤10 mm in high-risk patients unfit for open repair and fenestrated endograft.
作者信息
Gallitto Enrico, Gargiulo Mauro, Freyrie Antonio, Bianchini Massoni Claudio, Pini Rodolfo, Mascoli Chiara, Faggioli Gianluca, Stella Andrea
机构信息
Vascular Surgery, Department of Experimental, Diagnostic, and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Azienda Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
Vascular Surgery, Department of Experimental, Diagnostic, and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Azienda Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
出版信息
J Vasc Surg. 2016 Sep;64(3):563-570.e1. doi: 10.1016/j.jvs.2016.02.018. Epub 2016 May 13.
OBJECTIVE
The aim of this study was to evaluate long-term outcomes of endovascular aneurysm repair (EVAR) using a standard suprarenal fixation endograft in abdominal aortic aneurysms (AAAs) with infrarenal neck length ≤10 mm (short-neck AAA [SN-AAA]).
METHODS
From 2005 to 2010, data of high-risk patients with SN-AAA, unfit for open repair (OR) and fenestrated EVAR, were prospectively collected. Follow-up was performed by duplex ultrasound and contrast-enhanced ultrasound or computed tomography angiography at 1 month, 6 months, and 12 months and yearly thereafter. The primary end point was AAA-related mortality. Secondary end points were proximal type I endoleak, freedom from reintervention, and AAA shrinkage (>5 mm).
RESULTS
Sixty patients (mean age, 74.9 ± 6.2 years; American Society of Anesthesiologists class 3 [85%] and class 4 [15%]) were enrolled. The mean aneurysm diameter and neck length and diameter were 60.4 ± 12.2 mm, 8.4 ± 1.6 mm, and 23.5 ± 3 mm, respectively. Four (7%) patients were symptomatic and 15 (25%) had rapid AAA enlargement (>5 mm/6 months). Cook Zenith Flex (Cook Medical, Bloomington, Ind) endografts (32) and Medtronic Endurant (Medtronic, Santa Rosa, Calif) endografts (28) were implanted. The mean follow-up was 51 ± 18 months. Survival at 5 years was 70%. There were three (5%) type I endoleaks. One was sealed by endovascular reintervention, and two (3%) underwent conversion to OR for AAA rupture at 8 and 36 months. Both patients died (2/60; 3% AAA-related mortality). Reinterventions were necessary for another five (8%) patients, and they were not proximal neck related. Freedom from reintervention at 5 years was 90%. In 49 (82%) cases, there was AAA shrinkage; the AAA diameter remained stable in nine (15%) and increased in two (3%) cases. Severe proximal angle (α neck angle ≥60 degrees) was associated with type I endoleak (P = .010) and reinterventions (P = .010). The neck length <7 mm (P = .030) was associated with reinterventions (P = .017).
CONCLUSIONS
Suprarenal fixation EVAR in SN-AAA with a straight, not wide neck and 7- to 10-mm aortic neck length can be considered safe and effective in patients who are unfit for OR and fenestrated EVAR. For these cases, long-term data showed acceptable results in preventing aneurysm rupture and related mortality.
目的
本研究旨在评估使用标准肾上固定型腔内移植物对肾下颈部长度≤10 mm的腹主动脉瘤（AAA，即短颈AAA [SN-AAA]）进行血管腔内动脉瘤修复术（EVAR）的长期疗效。
方法
前瞻性收集2005年至2010年不适于开放修复术（OR）和开窗EVAR的高危SN-AAA患者的数据。术后1个月、6个月和12个月以及此后每年通过双功超声、对比增强超声或计算机断层血管造影进行随访。主要终点是与AAA相关的死亡率。次要终点是近端I型内漏、无需再次干预以及AAA缩小（>5 mm）。
结果
纳入60例患者（平均年龄74.9±6.2岁；美国麻醉医师协会分级3级[85%]和4级[15%]）。平均动脉瘤直径、颈部长度和直径分别为60.4±12.2 mm、8.4±1.6 mm和23.5±3 mm。4例（7%）患者有症状，15例（25%）有AAA快速增大（>5 mm/6个月）。植入了Cook Zenith Flex（Cook Medical，印第安纳州布卢明顿）腔内移植物（32例）和美敦力Endurant（美敦力，加利福尼亚州圣罗莎）腔内移植物（28例）。平均随访时间为51±18个月。5年生存率为70%。有3例（5%）I型内漏。1例通过血管腔内再次干预封堵，2例（3%）分别在8个月和36个月时因AAA破裂转为开放修复术。这2例患者均死亡（2/60；3%与AAA相关的死亡率）。另外5例（8%）患者需要再次干预，且与近端颈部无关。5年时无需再次干预的比例为90%。49例（82%）出现AAA缩小；9例（15%）AAA直径保持稳定，2例（3%）增大。严重的近端角度（α颈部角度≥60度）与I型内漏（P = .010）和再次干预（P = .010）相关。颈部长度<7 mm（P = .030）与再次干预（P = .017）相关。
结论
对于不适于开放修复术和开窗EVAR的患者，在颈部直且不宽、主动脉颈部长度为7至10 mm的SN-AAA中，肾上固定EVAR可被认为是安全有效的。对于这些病例，长期数据显示在预防动脉瘤破裂和相关死亡率方面有可接受的结果。
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