Szaniewski Krzysztof, Biernacka Magdalena, Walas Ryszard L, Zembala Marian
St. Barbara Provincial Specialist Hospital No. 5, Sosnowiec, Poland.
Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Poland.
Kardiochir Torakochirurgia Pol. 2016 Dec;13(4):334-339. doi: 10.5114/kitp.2016.64876. Epub 2016 Dec 30.
Various modifications of standard endovascular aortic aneurysm repair (EVAR) have been developed to solve the problem of difficult neck anatomy.
The authors propose the implantation of a predeployed extension cuff (kilt) using on-shelf Endurant II elements. In a vast majority of cases, the proposed method provides a solution for the hostile neck problem using standard Endurant II elements available in all centers performing subrenal EVAR procedures.
The early outcomes of kilt implantation were evaluated in 11 patients (three with ruptured abdominal aortic aneurysms, one symptomatic) in 2 vascular centers in Silesia (Poland). All patients presented with hostile neck anatomy defined as neck length < 10 mm, diameter > 28 mm, angulation > 60°, mural thrombus or calcium > 2 mm in thickness or > 180° circumference.
No intraoperative type I endoleak or device migration was observed. Two perioperative deaths occurred in patients in a severe condition with ruptured aneurysms. One case of type III endoleak was managed by the implantation of an additional iliac extension with complete endoleak sealing.
The proposed method seems to be effective in early endoleak prevention in patients with hostile neck anatomy undergoing EVAR procedures; however, studies with long-term follow-up are needed.
为解决颈部解剖结构复杂的问题，人们开发了多种标准血管腔内主动脉瘤修复术（EVAR）的改良术式。
作者提出使用现成的Endurant II组件植入预先展开的延长袖套（百褶裙）。在绝大多数情况下，该方法能利用所有进行肾下EVAR手术的中心都有的标准Endurant II组件，解决棘手的颈部问题。
在波兰西里西亚的2个血管中心，对11例患者（3例腹主动脉瘤破裂，1例有症状）进行了百褶裙植入的早期结果评估。所有患者的颈部解剖结构均较为复杂，定义为颈部长度<10毫米、直径>28毫米、成角>60°、有壁血栓或钙化厚度>2毫米或圆周>180°。
未观察到术中I型内漏或器械移位。2例病情严重的动脉瘤破裂患者围手术期死亡。1例III型内漏通过植入额外的髂动脉延长段并完全封闭内漏进行处理。
对于接受EVAR手术且颈部解剖结构复杂的患者，该方法似乎能有效预防早期内漏；然而，仍需要进行长期随访研究。
