Abdulrasak M, Resch T, Sonesson B, Holst J, Kristmundsson T, Dias N V
Vascular Center, Skåne University Hospital, Malmö, Sweden.
Vascular Center, Skåne University Hospital, Malmö, Sweden.
Eur J Vasc Endovasc Surg. 2017 Jan;53(1):69-76. doi: 10.1016/j.ejvs.2016.10.004. Epub 2016 Nov 25.
OBJECTIVE/BACKGROUND: The objective was to analyze the long-term durability of intra-operatively placed Palmaz stents for type Ia endoleaks, and the evolution of aneurysm neck morphology.
This was a retrospective cohort study conducted at a tertiary referral centre. Patients treated between 1998 and 2012 were reviewed with regard to pre-, intra-, and post-operative data. Crude and relative survival estimates were calculated, with the latter referring only to patients with ≥ 3 months' follow-up.
In total, 125 patients were included (83 elective, 22 ruptures, 20 symptomatic). Nine patients died perioperatively (two elective, seven acute). Median follow-up was 43 months (range 15-72). Seven patients had late abdominal aortic aneurysm related deaths. There were 51 re-interventions (seven type Ia endoleak related). Five year crude primary, primary assisted, and secondary success rates were 55 ± 5%, 66 ± 5%, and 70 ± 5%, respectively. These crude rates were superior for elective patients (p = .008, p = .031, and p = .037, respectively), but the relative rates were not (p = .187, p = .640, p = .558, respectively). Primary and assisted freedom from type Ia endoleak 5 years post-operatively were 84 ± 4% and 89 ± 3%, respectively. These rates were superior in elective patients (p = .066 and p = .145, respectively), especially when relative rates were analysed (p = .025 and p = .063, respectively). The visceral aortic diameter increased significantly between the first and the last post-operative imaging in 15/91 (16%), 12/91 (13%), 34/91 (37%), and 30/91 (33%) patients at the levels of coeliac trunk, superior mesenteric artery, lowest renal artery, and 9 mm distal to lowest renal artery, respectively.
Intra-operatively placed Palmaz stents confer high long-term freedom from type Ia endoleak. Palmaz stents are an acceptable intra-operative bailout tool in the acute setting, but should not be used to extend elective infrarenal endovascular aneurysm repair to more demanding anatomies.
目的/背景：目的是分析术中置入帕尔马兹支架治疗Ia型内漏的长期耐久性，以及瘤颈形态的演变。
这是一项在三级转诊中心进行的回顾性队列研究。对1998年至2012年期间接受治疗的患者的术前、术中和术后数据进行了回顾。计算了粗生存率和相对生存率，后者仅指随访时间≥3个月的患者。
总共纳入了125例患者（83例择期手术，22例破裂，20例有症状）。9例患者围手术期死亡（2例择期手术，7例急性死亡）。中位随访时间为43个月（范围15 - 72个月）。7例患者死于晚期腹主动脉瘤相关疾病。有51例再次干预（7例与Ia型内漏相关）。五年粗原发成功率、原发辅助成功率和继发成功率分别为55±5%、66±5%和70±5%。这些粗率在择期患者中更高（分别为p = 0.008、p = 0.031和p = 0.037），但相对率并非如此（分别为p = 0.187、p = 0.640、p = 0.558）。术后5年Ia型内漏的原发和辅助无内漏率分别为84±4%和89±3%。这些率在择期患者中更高（分别为p = 0.066和p = 0.145），尤其是在分析相对率时（分别为p = 0.025和p = 0.063）。在腹腔干、肠系膜上动脉、最低肾动脉水平以及最低肾动脉远端9毫米处，分别有15/91（16%）、12/91（13%）、34/91（37%）和30/91（33%）的患者在首次和最后一次术后影像学检查之间内脏主动脉直径显著增加。
术中置入帕尔马兹支架可使Ia型内漏长期保持低发生率。帕尔马兹支架在急性情况下是一种可接受的术中补救工具，但不应被用于将择期肾下血管内动脉瘤修复扩展至解剖结构更复杂的情况。
