Blankensteijn Louise L, Dijkstra Martijn L, Tielliu Ignace F J, Reijnen Michel M P J, Zeebregts Clark J
Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
J Vasc Surg. 2017 Feb;65(2):303-310. doi: 10.1016/j.jvs.2016.08.092. Epub 2016 Oct 28.
The fenestrated Anaconda endograft (Vascutek, Renfrewshire, Scotland) was introduced in 2010 and showed promising short-term results with high technical success and low morbidity rates. The aim of this study was to present the midterm results, with a minimum of 12 months follow-up, for all patients treated with the fenestrated Anaconda endograft in The Netherlands.
Patients treated with the fenestrated Anaconda endograft between May 2011 and February 2015 were included. Follow-up consisted of computed tomography angiography at 1 month and 1 year, and duplex ultrasound yearly thereafter with additional computed tomography angiography if indicated using a standard protocol.
A total of 60 patients were included; 48 patients (80.0%) were treated for juxtarenal aneurysms, and 12 (20.0%) were short-neck infrarenal aneurysms. Mean aneurysm size was 64 ± 9 mm. A total of 140 fenestrations were incorporated. Median follow-up was 16.4 months (interquartile range, 11.9-27.4). The 30-day mortality was 3.4% (n = 2). Kaplan-Meier estimates for 1-year, 2-year, and 3-year survival were 91.4%, 89.5%, and 86.3%, respectively, without aneurysm-related mortality during follow-up. Main body primary and secondary endograft patencies were 98.3% and 100%, respectively. Target vessel primary and secondary patencies were 95.0% and 98.6%, respectively. Early type IA endoleaks occurred in seven patients (11.7%) and spontaneously resolved in all patients. At 1-year follow-up 4 (6.7%) type II endoleaks persisted. One patient experienced aneurysm rupture because of a late type III endoleak attributable to a dislodged renal stent and subsequently underwent successful conversion to open surgery.
The fenestrated Anaconda is a viable treatment option for complex abdominal aortic aneurysms. Acceptable mortality and morbidity and low reintervention rates contribute to good midterm results. Occurrence of early type I endoleak was relatively common, but these resolved spontaneously in all patients.
带开窗的Anaconda血管内移植物（Vascutek公司，苏格兰伦弗鲁郡）于2010年推出，短期结果显示技术成功率高且发病率低，前景良好。本研究的目的是报告在荷兰接受带开窗Anaconda血管内移植物治疗的所有患者的中期结果，随访时间至少为12个月。
纳入2011年5月至2015年2月期间接受带开窗Anaconda血管内移植物治疗的患者。随访包括在1个月和1年时进行计算机断层扫描血管造影，此后每年进行双功超声检查，如有必要则按照标准方案进行额外的计算机断层扫描血管造影。
共纳入60例患者；48例（80.0%）治疗近肾动脉瘤，12例（20.0%）治疗短颈肾下动脉瘤。动脉瘤平均大小为64±9mm。共植入140个开窗。中位随访时间为16.4个月（四分位间距，11.9 - 27.4）。30天死亡率为3.4%（n = 2）。Kaplan-Meier法估计1年、2年和3年生存率分别为91.4%、89.5%和86.3%，随访期间无动脉瘤相关死亡。主体移植物的初级和次级通畅率分别为98.3%和100%。靶血管的初级和次级通畅率分别为95.0%和98.6%。7例患者（11.7%）出现早期IA型内漏，所有患者内漏均自发消失。在1年随访时，4例（6.7%）II型内漏持续存在。1例患者因肾支架移位导致晚期III型内漏而发生动脉瘤破裂，随后成功转为开放手术。
带开窗的Anaconda血管内移植物是治疗复杂腹主动脉瘤的一种可行选择。可接受的死亡率和发病率以及较低的再次干预率促成了良好的中期结果。早期I型内漏的发生相对常见，但所有患者内漏均自发消失。
