Giménez-Gaibar Antonio, González-Cañas Elena, Solanich-Valldaura Teresa, Herranz-Pinilla Carolina, Rioja-Artal Sara, Ferraz-Huguet Elisabeth
Department of Vascular Surgery, Hospital Universitario Parc Tauli, Sabadell, Barcelona, Spain.
Department of Vascular Surgery, Hospital Universitario Parc Tauli, Sabadell, Barcelona, Spain.
Ann Vasc Surg. 2017 Aug;43:127-133. doi: 10.1016/j.avsg.2016.12.011. Epub 2017 Apr 6.
The aim of the study was to assess the clinical utility of strict CT scan surveillance after endovascular abdominal aneurysm repair (EVAR) and evaluate whether the anatomy of abdominal aortic aneurysm (AAA) neck (favorable/hostile) influences regular imaging control.
A retrospective study of AAA patients who underwent EVAR with aortobi-iliac endoprostheses during 2006-2013 was conducted. Exclusion criteria included other types of devices. Variables analyzed were technical and clinical success, morbimortality, complications (such as endoleaks, sac enlargement), reinterventions, reintervention-free survival, and survival rate. Preoperative CT scans were performed and repeated at 1, 6 (in selective cases), 12, and 24 months postoperatively. Patients were divided into two groups according to preoperative anatomic characteristics: group I (favorable neck) and group II (hostile neck: angle > 60°, length < 15 mm, diameter > 28 mm, and calcification or circumference thrombus ≥50%).
A total of 127 patients with AAA (96.8% male) were included in the study. The mean age of the patients was 75.9 years (range: 51-90 years). The mean AAA diameter was 62.1 mm. Hostile neck was found in 52 patients (40.9%). The technical and clinical success rate was 100% and 30-day mortality was 0.8%. The reintervention-free survival rate was 97.6%, 96.1%, and 93.7% and the survival rate was 97.6%, 96.9%, and 91.3%, during follow-up at 6, 12, and 24 months, respectively. Accumulated complications in proximal sealing occurred in 0%, 0%, and 1.6% in group I and 1.9%, 6.1%, and 7.7% in group II at 1, 12, and 24 months, respectively. Type II endoleaks occurred in 24.3%, 14.3%, and 11.4% in group I and 9.8%, 6.3%, and 6.8% in group II at 1, 12, and 24 months, respectively. No increased diameter was detected at 6 and 12 months. No differences were observed in reinterventions and mortality rate depending on anatomy.
CT scans performed at 6 and 12 months postoperatively did not detect complications or need for reintervention in patients with favorable necks, even in the presence of endoleaks type II, and could therefore be omitted. Hostile necks may compromise proximal sealing and require regular imaging follow-ups.
本研究旨在评估血管腔内腹主动脉瘤修复术（EVAR）后严格CT扫描监测的临床实用性，并评估腹主动脉瘤（AAA）颈部解剖结构（有利/不利）是否会影响定期影像学检查。
对2006年至2013年间接受带主动脉-双侧髂动脉内支架的EVAR治疗的AAA患者进行回顾性研究。排除标准包括其他类型的器械。分析的变量包括技术和临床成功率、病死率、并发症（如内漏、瘤体增大）、再次干预、无再次干预生存率和生存率。术前进行CT扫描，并在术后1、6个月（部分病例）、12个月和24个月重复扫描。根据术前解剖特征将患者分为两组：I组（颈部有利）和II组（颈部不利：角度>60°、长度<15mm、直径>28mm、钙化或周向血栓≥50%）。
本研究共纳入127例AAA患者（96.8%为男性）。患者的平均年龄为75.9岁（范围：51 - 90岁）。AAA的平均直径为62.1mm。52例患者（40.9%）存在不利颈部。技术和临床成功率为100%，30天死亡率为0.8%。在术后6、12和24个月的随访中，无再次干预生存率分别为97.6%、96.1%和93.7%，生存率分别为97.6%、96.9%和91.3%。I组在术后1、12和24个月近端密封处累积并发症发生率分别为0%、0%和1.6%，II组分别为1.9%、6.1%和7.7%。I组在术后1、12和24个月II型内漏发生率分别为24.3%、14.3%和11.4%，II组分别为9.8%、6.3%和6.8%。在6个月和12个月时未检测到直径增加。根据解剖结构，在再次干预和死亡率方面未观察到差异。
术后6个月和12个月进行的CT扫描未发现颈部有利患者出现并发症或需要再次干预，即使存在II型内漏，因此可以省略。不利颈部可能会影响近端密封，需要定期进行影像学随访。
