Matsagkas Miltiadis I, Kouvelos George, Spanos Konstantinos, Athanasoulas Athanasios, Giannoukas Athanasios
Department of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Vascular Surgery Unit, Department of Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
Interact Cardiovasc Thorac Surg. 2017 Jul 1;25(1):1-5. doi: 10.1093/icvts/ivx087.
Our goal was to evaluate the use of an AFX main body combined with an Endurant proximal aortic cuff to treat selected patients with an abdominal aortic aneurysm (AAA) associated with anatomical challenges, such as a small distal aortic diameter and a hostile aortic neck. A retrospective analysis of prospectively collected data from 2 vascular institutions identified 14 elective patients with an AAA (all men, 73.5 ± 5.1 years) treated with the AFX main body combined with an Endurant proximal aortic cuff. Patients had a small distal aortic diameter (median 19 mm) and a short or angulated proximal aortic neck (median length 20 mm, range 9-26 mm, median angulation 41.5°, range 23-80°). Six patients (42.9%) had an aortic neck that did not meet the indications for use of the AFX proximal aortic cuff. Primary technical success was achieved in all patients with no 30-day device-related complications or deaths. During a median follow-up period of 13 months (range 6-28 months), no re-intervention was needed. The diameter of the aneurysmal sac decreased from 57.6 ± 5.6 mm preoperatively to 50.4 ± 4.9 mm (P < 0.001) postoperatively. There were no aneurysm-related deaths or ruptures. No migration, disconnection or type I or III endoleak was observed. In 5 of the 6 patients, the initial type II endoleak spontaneously resolved during follow-up, whereas that in the remaining patient persisted without any change in the diameter of the aneurysmal sac. In patients with complex AAA anatomical configurations combining a hostile aortic neck and a narrow aortic bifurcation, the use of an AFX main body combined with an Endurant proximal aortic cuff seems to be feasible with favourable mid-term results.
我们的目标是评估使用AFX主体结合Endurant近端主动脉袖带治疗选定的伴有解剖学挑战的腹主动脉瘤（AAA）患者，这些挑战包括远端主动脉直径小和主动脉颈部情况不佳。对来自2个血管机构的前瞻性收集数据进行回顾性分析，确定了14例接受AFX主体结合Endurant近端主动脉袖带治疗的择期AAA患者（均为男性，73.5±5.1岁）。患者远端主动脉直径小（中位数19mm），近端主动脉颈部短或成角（中位数长度20mm，范围9 - 26mm，中位数成角41.5°，范围23 - 80°）。6例患者（42.9%）的主动脉颈部不符合使用AFX近端主动脉袖带的指征。所有患者均取得了主要技术成功，无30天与器械相关的并发症或死亡。在中位随访期13个月（范围6 - 28个月）内，无需再次干预。瘤囊直径从术前的57.6±5.6mm降至术后的50.4±4.9mm（P<0.001）。无与动脉瘤相关的死亡或破裂。未观察到移位、脱节或I型或III型内漏。6例患者中有5例，初始的II型内漏在随访期间自发消失，而其余患者的II型内漏持续存在，瘤囊直径无任何变化。对于合并主动脉颈部情况不佳和主动脉分叉狭窄的复杂AAA解剖结构患者，使用AFX主体结合Endurant近端主动脉袖带似乎是可行的，中期结果良好。
