Vourliotakis Georgios D, Tzilalis Vasileios D, Theodoridis Panagiotis G, Stoumpos Charalampos S, Kamvysis Dimitrios G, Kantounakis Ioannis G
Department of Surgery, Division of Vascular Surgery, 401 General Military Hospital of Athens, Athens, Greece.
Department of Surgery, Division of Vascular Surgery, 401 General Military Hospital of Athens, Athens, Greece.
Ann Vasc Surg. 2017 Apr;40:154-161. doi: 10.1016/j.avsg.2016.07.078. Epub 2016 Nov 24.
The aim of this study is to present our early experience and highlight the technical difficulties associated with the use of fenestrated and branched stent grafts to treat patients with juxtarenal abdominal aortic aneurysm (AAA), pararenal AAA, and thoracoabdominal aortic aneurysms (TAAAs).
A prospectively held database maintained at our department was queried for patients who have undergone branched and fenestrated stent grafting for AAA or TAAA treatment. Indication for repair, comorbidity precluding open repair, technical challenges associated with the repair, as well as operative mortality, morbidity, and reintervention rate were evaluated.
A total of 8 patients underwent repair with a fenestrated or branched stent graft. All patients had aneurysmal degeneration of the juxtarenal aorta, pararenal aorta, and thoracoabdominal aorta not suitable to standard endovascular techniques. Two patients had a prior aortic repair, a failed migrated stent graft, and an old surgical tube graft after an open repair. One patient had a type III TAAA and 1 patient had a postdissection TAAA type I. For all patients, target vessel success rate was 96.4% (27/28) and mean hospital stay was 6.0 days (range 3-21). Thirty-day and 1-year mortality were 0%. Mean follow-up was 23 months (range 7-45). Two endoleaks occurred, 1 type III and 1 type II, which were treated endovascularly. No death or major complication occurred during follow-up.
Fenestrated and branched endovascular stent grafts can be used to repair juxtarenal AAA, pararenal AAA, and TAAA in patients with significant comorbidities. However, several technical challenges have to be overcome due to the unique complex aortic pathology of each patient.
本研究的目的是介绍我们的早期经验，并强调使用开窗和分支型覆膜支架治疗近肾腹主动脉瘤（AAA）、肾旁AAA和胸腹主动脉瘤（TAAA）患者时所面临的技术困难。
查询我们科室前瞻性维护的数据库，以获取接受分支和开窗覆膜支架植入术治疗AAA或TAAA的患者。评估修复指征、排除开放修复的合并症、与修复相关的技术挑战以及手术死亡率、发病率和再次干预率。
共有8例患者接受了开窗或分支型覆膜支架修复术。所有患者均患有近肾主动脉、肾旁主动脉和胸腹主动脉的动脉瘤样退变，不适合采用标准的血管内技术。2例患者曾接受过主动脉修复术，1例患者的覆膜支架移位失败，1例患者在开放修复术后有陈旧性外科人工血管。1例患者患有III型TAAA，1例患者患有I型夹层后TAAA。所有患者的靶血管成功率为96.4%（27/28），平均住院天数为6.0天（范围3 - 21天）。30天和1年死亡率均为0%。平均随访时间为23个月（范围7 - 45个月）。发生了2例内漏，1例III型和1例II型，均采用血管内治疗。随访期间未发生死亡或重大并发症。
开窗和分支型血管内覆膜支架可用于修复合并严重合并症的近肾AAA、肾旁AAA和TAAA。然而，由于每位患者独特的复杂主动脉病理情况，必须克服若干技术挑战。
