Groot Jebbink Erik, Ter Mors Thijs G, Slump Cornelis H, Geelkerken Robert H, Holewijn Suzanne, Reijnen Michel Mpj
1 Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
2 MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
Vascular. 2017 Dec;25(6):635-641. doi: 10.1177/1708538117708912. Epub 2017 May 22.
Objectives Various configurations of kissing stent (KS) configurations exist and patency rates vary. In response the covered endovascular reconstruction of the aortic bifurcation configuration was designed to minimize mismatch and improve outcome. The aim of the current study is to compare geometrical mismatch of kissing stent with the covered endovascular reconstruction of the aortic bifurcation configuration in vivo. Methods Post-operative computed tomographic data and patient demographics from 11 covered endovascular reconstruction of the aortic bifurcation and 11 matched kissing stent patients were included. A free hand region of interest and ellipse fitting method were applied to determine mismatch areas and volumes. Conformation of the stents to the vessel wall was expressed using the D-ratio. Results Patients were mostly treated for Rutherford category 2 and 3 (64%) with a lesion classification of TASC C and D in 82%. Radial mismatch area and volume for the covered endovascular reconstruction of the aortic bifurcation group was significantly lower compared to the kissing stent configuration ( P < 0.05). The D-ratio did not significantly differ between groups. Measurements were performed with good intra-class correlation. There were no significant differences in the post-procedural aortoiliac anatomy. Conclusions The present study shows that radial mismatch exists in vivo and that large differences in mismatch exist, in favour of the covered endovascular reconstruction of the aortic bifurcation configuration. Future research should determine if the decreased radial mismatch results in improved local flow profiles and subsequent clinical outcome.
目的 存在多种吻接支架（KS）构型，其通畅率各不相同。作为回应，设计了主动脉分叉构型的覆膜血管腔内重建术以尽量减少不匹配并改善治疗效果。本研究的目的是在体内比较吻接支架与主动脉分叉构型的覆膜血管腔内重建术的几何不匹配情况。方法 纳入了11例主动脉分叉覆膜血管腔内重建术患者和11例匹配的吻接支架患者的术后计算机断层扫描数据及患者人口统计学资料。应用徒手感兴趣区和椭圆拟合方法来确定不匹配面积和体积。使用D值来表示支架与血管壁的贴合情况。结果 患者大多接受了针对卢瑟福分级2级和3级（64%）的治疗，82%的病变分类为TASC C级和D级。与吻接支架构型相比，主动脉分叉覆膜血管腔内重建术组的径向不匹配面积和体积显著更低（P < 0.05）。两组之间的D值无显著差异。测量具有良好的组内相关性。术后主动脉髂部解剖结构无显著差异。结论 本研究表明体内存在径向不匹配，且不匹配存在很大差异，有利于主动脉分叉构型的覆膜血管腔内重建术。未来的研究应确定径向不匹配的减少是否会导致局部血流情况改善及随后的临床结果改善。
