Roy I N, Millen A M, Jones S M, Vallabhaneni S R, Scurr J R H, McWilliams R G, Brennan J A, Fisher R K
Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
Br J Surg. 2017 Jul;104(8):1020-1027. doi: 10.1002/bjs.10524. Epub 2017 Apr 12.
Fenestrated endovascular aneurysm repair (FEVAR) is increasingly being used for juxtarenal aortic aneurysms. The aim of this study was to review long-term results and assess the importance of changing stent-graft design on outcomes.
This was a retrospective review of all patients who underwent FEVAR within a single unit over 12 years (February 2003 to December 2015). Kaplan-Meier analysis of survival, and freedom from target vessel loss, aneurysm expansion, graft-related endoleak and secondary intervention was performed. Comparison between outcomes of less complex grafts (fewer than 3 fenestrations) and more complex grafts (3 or 4 fenestrations) was undertaken.
Some 173 patients underwent FEVAR; median age was 76 (i.q.r. 70-79) years and 90·2 per cent were men. Median aneurysm diameter was 63 (59-71) mm and median follow-up was 34 (16-50) months. The adjusted primary technical operative success rate was 95·4 per cent. The in-hospital mortality rate was 5·2 per cent; there was no known aneurysm-related death during follow-up. Median survival was 7·1 (95 per cent c.i. 5·2 to 8·1) years and overall survival was 60·1 per cent (104 of 173). There was a trend towards an increasing number of fenestrations in the graft design over time. In-hospital mortality appeared higher when more complex stent-grafts were used (8 versus 2 per cent for stent-grafts with 3-4 versus fewer than 3 fenestrations; P = 0·059). Graft-related endoleaks were more common following deployment of stent-grafts with three or four fenestrations (12 of 90 versus 6 of 83; P < 0·001).
Fenestrated endovascular aneurysm repair for juxtarenal aneurysm is associated with few aneurysm-related deaths in the long term. Significant numbers of secondary interventions are required, but the majority of these can be performed using an endovascular approach.
开窗型血管内动脉瘤修复术（FEVAR）越来越多地用于近肾主动脉瘤。本研究的目的是回顾长期结果，并评估改变支架移植物设计对预后的重要性。
这是一项对12年内（2003年2月至2015年12月）在单一机构接受FEVAR的所有患者的回顾性研究。采用Kaplan-Meier分析生存率、无靶血管丢失、动脉瘤扩大、移植物相关内漏和二次干预情况。对较简单移植物（开窗少于3个）和较复杂移植物（开窗3个或4个）的预后进行比较。
约173例患者接受了FEVAR；中位年龄为76（四分位间距70 - 79）岁，男性占90.2%。中位动脉瘤直径为63（59 - 71）mm，中位随访时间为34（16 - 50）个月。调整后的主要技术手术成功率为95.4%。住院死亡率为5.2%；随访期间无已知的动脉瘤相关死亡。中位生存期为7.1（95%可信区间5.2至8.1）年，总生存率为60.1%（173例中的104例）。随着时间推移，移植物设计中的开窗数量有增加趋势。使用更复杂的支架移植物时住院死亡率似乎更高（开窗3 - 4个的支架移植物为8%，开窗少于3个的为2%；P = 0.059）。在植入有三个或四个开窗的支架移植物后，移植物相关内漏更常见（90例中的12例对83例中的6例；P < 0.001）。
近肾动脉瘤的开窗型血管内动脉瘤修复术长期来看与极少的动脉瘤相关死亡相关。需要大量的二次干预，但其中大多数可以采用血管内方法进行。
