Titus Jessica M, Cragg Andrew, Alden Peter, Alexander Jason, Manunga Jesse, Stephenson Elliot, Skeik Nedaa, Sullivan Timothy
Department of Vascular and Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn.
Department of Vascular and Endovascular Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn.
J Vasc Surg. 2017 Aug;66(2):387-391. doi: 10.1016/j.jvs.2017.01.038. Epub 2017 Apr 19.
The objective of this study was to compare snare vs the standard retrograde gate cannulation method during endovascular aneurysm repair to determine the most efficient technique and to evaluate whether time was affected by graft design or the surgeon's experience.
This was a prospective randomized study involving single-center elective endovascular aneurysm repairs. Patients were randomized to the snare or retrograde group in a 1:1 ratio. The initial method was attempted for 15 minutes; if it was unsuccessful, the team switched to the alternative technique for an additional 15 minutes. The protocol continued until success was achieved. Data collected on demographic, anatomic, and procedural factors were analyzed for statistically significant differences.
A total of 101 patients were included. Average age was 75.3 years, and 82% were male; 49 patients were randomized to snare and 52 to retrograde cannulation. The groups were overall similar. Median cannulation times were 3.9 minutes for the snare and 2.7 minutes for the retrograde technique (P = .13). The snare group attempts were successful within the initial 15-minute period in all but one patient (98% success). In the retrograde group, 5 of the 52 (10%) crossed over to snare. This difference did not reach statistical significance (P = .11). A difference was seen in the extremes of cannulation times. The surgeon's experience and graft design were not found to have significant effects on cannulation times. Further analysis of the retrograde group patients with long cannulation time found a relative breakpoint at the 5-minute mark. In those exceeding this time mark, the chance of eventual cannulation within 15 minutes dropped to 67%. In this group, median time to cannulation was 12.2 minutes for retrograde compared with 7.1 minutes for snare after crossover.
Gate cannulation was successful using both methods with no statistical difference between the two in median time. Retrograde cannulation was found to be more likely to have short times. If cannulation by retrograde technique had not been achieved in the first 5 minutes, the chances of eventual success dropped significantly, and crossover to snare was more efficient. This finding suggests that one should consider an alternative method of gate cannulation if it has not been accomplished within this time.
本研究的目的是比较血管内动脉瘤修复术中圈套器与标准逆行入路插管方法，以确定最有效的技术，并评估时间是否受移植物设计或外科医生经验的影响。
这是一项前瞻性随机研究，涉及单中心择期血管内动脉瘤修复术。患者按1:1的比例随机分为圈套器组或逆行组。初始方法尝试15分钟；如果不成功，团队改用另一种技术再进行15分钟。该方案持续进行直至成功。对收集的人口统计学、解剖学和手术因素数据进行分析，以寻找统计学上的显著差异。
共纳入101例患者。平均年龄为75.3岁，82%为男性；49例患者随机分配至圈套器组，52例至逆行插管组。两组总体相似。圈套器组的中位插管时间为3.9分钟，逆行技术组为2.7分钟（P = 0.13）。除1例患者外，圈套器组的尝试在最初15分钟内均成功（成功率98%）。在逆行组中，52例中有5例（10%）改用圈套器。这种差异未达到统计学显著性（P = 0.11）。在插管时间的极端值上存在差异。未发现外科医生的经验和移植物设计对插管时间有显著影响。对逆行组插管时间长的患者进行进一步分析发现，在5分钟标记处有一个相对的转折点。在超过这个时间标记的患者中，15分钟内最终插管成功的几率降至67%。在该组中，逆行插管的中位时间为12.2分钟，改用圈套器后为7.1分钟。
两种方法进行入路插管均成功，中位时间两者无统计学差异。发现逆行插管更有可能用时较短。如果逆行技术在最初5分钟内未成功插管，最终成功的几率会显著下降，改用圈套器更有效。这一发现表明，如果在此时间内未完成入路插管，应考虑采用另一种方法。
