Delay Charline, Deglise Sébastien, Lejay Anne, Georg Yannick, Roussin Mathieu, Schaeffer Mickaël, Saucy François, Thaveau Fabien, Corpataux Jean-Marc, Chakfe Nabil
Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France.
Department of Vascular Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
Ann Vasc Surg. 2017 May;41:141-150. doi: 10.1016/j.avsg.2016.08.048. Epub 2017 Feb 24.
The aim of this study is to evaluate the short- and mid-term results of the Zenith bifurcated iliac side branch device (ZBIS) in the treatment of common iliac artery (CIA) aneurysms, and to assess risk factors for intraoperative internal iliac artery (IIA) thrombosis.
All patients who underwent endovascular treatment of either an isolated CIA aneurysm or an aortoiliac aneurysm using the ZBIS device in the departments of vascular surgery of Strasbourg (France) and Lausanne (Switzerland) between January 2010 and December 2014 were retrospectively collected.
Thirty-one implantations were performed: 30 patients underwent 31 endovascular CIA aneurysm treatments with the ZBIS device. Mean operative time was 188 min. Technical success was obtained in 26 implantations (84%). In 5 implantations (16%), the final angiogram revealed an IIA thrombosis. Thirty-day mortality was 3.2%. Thirty-day morbidity was 13.3%. Mean follow-up was 15 months. Overall survival was 96% at 1 year and 89% at 2 years. In intention-to-treat analysis, primary patency of the internal iliac side branch was 84% at 1 year and 76% at 2 years (5 peroperative IIA occlusions and 1 late occlusion). Freedom from reintervention was 89% at 1 and 2 years. One case of type III endoleak and 2 cases of type II endoleaks were identified. Only type III endoleak required an additional intervention with a covered stent. Aneurysm diameter decreased in 15 implantations (48%) and remained stable in 16 implantations (52%). Clinical, radiological, and peroperative parameters were analyzed to identify risk factor for intraoperative thrombosis of the internal iliac side branch. Notion of intraoperative difficulties (any additional procedure that was not initially planned and increasing the operating time) appeared as a risk factor in multivariate analysis (P < 0.01, standard deviation 1.27, odds ratio 30.6).
The main findings of our study is that the procedure can be difficult to perform in particular conditions and can lead to peroperative failure in these cases, highlighting the need for adequate patients screening. When technical success is obtained, outcomes can be considered as satisfactory.
本研究旨在评估Zenith分叉髂支装置（ZBIS）治疗髂总动脉（CIA）动脉瘤的短期和中期结果，并评估术中髂内动脉（IIA）血栓形成的危险因素。
回顾性收集2010年1月至2014年12月期间在法国斯特拉斯堡和瑞士洛桑的血管外科使用ZBIS装置对孤立性CIA动脉瘤或主髂动脉瘤进行血管内治疗的所有患者。
共进行了31例植入手术：30例患者使用ZBIS装置进行了31次血管内CIA动脉瘤治疗。平均手术时间为188分钟。26例植入手术（84%）获得技术成功。5例植入手术（16%）的最终血管造影显示IIA血栓形成。30天死亡率为3.2%。30天发病率为13.3%。平均随访时间为15个月。1年时总生存率为96%，2年时为89%。在意向性分析中，髂内分支的原发性通畅率1年时为84%，2年时为76%（术中5例IIA闭塞，1例晚期闭塞）。1年和2年时无需再次干预的比例为89%。发现1例III型内漏和2例II型内漏。仅III型内漏需要使用覆膜支架进行额外干预。15例植入手术（48%）的动脉瘤直径减小，16例植入手术（52%）的动脉瘤直径保持稳定。对临床、影像学和术中参数进行分析，以确定髂内分支术中血栓形成的危险因素。术中困难的概念（任何最初未计划且增加手术时间的额外操作）在多变量分析中显示为危险因素（P<0.01，标准差1.27，比值比30.6）。
我们研究的主要发现是，该手术在特定情况下可能难以实施，并可能导致术中失败，这突出了对患者进行充分筛查的必要性。当获得技术成功时，结果可被认为是令人满意的。
