Law Y, Chan Y C, Cheng S Wk
Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Hong Kong Med J. 2016 Dec;22(6):538-45. doi: 10.12809/hkmj154799. Epub 2016 Oct 24.
The use of a proximal Palmaz stent is a well-recognised technique to treat proximal endoleak in endovascular aortic repair. This study aimed to report the effectiveness and safety of an intra-operative Palmaz stent for immediate type 1a endoleak in Hong Kong patients.
This case series was conducted at a tertiary hospital in Hong Kong. In a cohort of 494 patients who underwent infrarenal endovascular aortic repair from July 1999 to September 2015, 12 (2.4%) received an intra-operative proximal Palmaz stent for type 1a endoleak. Immediate and subsequent proximal endoleak on follow-up image was documented.
Morphological review of the pre-repair aneurysm neck showed five conical, one funnel, five cylindrical and one undetermined short neck, with a median neck angle of 61 degrees (range, 19-109 degrees). Stent grafts used included seven Cook Zenith, one Cook Aorto-Uni-Iliac device, three Metronic Endurant, and one TriVascular Ovation. Eleven Palmaz stents were placed successfully as intended, but one of them was accidentally placed too low. Of the 12 type 1a endoleaks, postoperative imaging revealed immediate resolution of eight whilst four had improved. After a median follow-up of 16 (range, 1-59) months, none of the subsequent imaging showed a type 1a endoleak. The mean size of the aneurysm sac reduced from 7.4 cm preoperatively to 7.3 cm at 1 month, 6.9 cm at 6 months, 7.1 cm at 1 year, and 6.1 cm at 2 years postoperatively. None of these patients required aortic reintervention or had device-related early- or mid-term mortality. One patient required delayed iliac re-interventions for an occluded limb at 10 days post-surgery.
In our cohort, Palmaz stenting was effective and safe in securing proximal sealing and fixation.
使用近端帕尔马兹支架是治疗血管腔内主动脉修复术中近端内漏的一种公认技术。本研究旨在报告术中使用帕尔马兹支架治疗香港患者1a型即刻内漏的有效性和安全性。
本病例系列研究在香港一家三级医院进行。在1999年7月至2015年9月期间接受肾下血管腔内主动脉修复术的494例患者中，12例（2.4%）因1a型内漏接受了术中近端帕尔马兹支架治疗。记录随访影像上的即刻及后续近端内漏情况。
修复术前动脉瘤颈部的形态学检查显示，有5个呈圆锥形、1个呈漏斗形、5个呈圆柱形和1个颈部形态不确定，颈部角度中位数为61度（范围为19 - 109度）。使用的覆膜支架包括7个库克·齐尼斯（Cook Zenith）、1个库克主动脉单髂动脉装置、3个美敦力Endurant和1个TriVascular Ovation。11个帕尔马兹支架按预期成功置入，但其中1个意外放置过低。在12例1a型内漏中，术后影像显示8例即刻消失，4例有所改善。中位随访16个月（范围为1 - 59个月）后，后续影像均未显示1a型内漏。动脉瘤囊的平均大小从术前的7.4 cm降至术后1个月时的7.3 cm、6个月时的6.9 cm、1年时的7.1 cm和2年时的6.1 cm。这些患者均无需进行主动脉再次干预，也没有与器械相关的早期或中期死亡。1例患者在术后10天因肢体闭塞需要进行延迟性髂动脉再次干预。
在我们的队列中，帕尔马兹支架置入术在确保近端密封和固定方面是有效且安全的。
