Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, Madrid, Spain.
Department of Vascular Surgery, Hospital Clinico San Carlos, Complutense University, Madrid, Spain.
J Vasc Surg. 2018 Jan;67(1):113-118. doi: 10.1016/j.jvs.2017.04.065. Epub 2017 Jun 26.
This study investigated the influence of the aortic bifurcation anatomy on the endovascular treatment of abdominal aortic aneurysms using Excluder (W. L. Gore & Associates, Flagstaff, Ariz) bifurcated stent grafts.
This was a retrospective single-center study of patients treated with the Excluder stent graft. Analysis included anatomical factors of the aortic bifurcation (aortic bifurcation diameter [ABD], calcification, thrombus), characteristics of the stent graft limbs (sum of stent graft limbs diameters [SLD]), and the SLD/ABD ratio. Narrow bifurcation was defined as ABD <20 mm. Primary outcomes were intraoperative stenosis, need for additional intraoperative measures, limb stenosis, and occlusion during follow-up.
The study included 232 patients. Mean ABD was 24.6 ± 6 mm, with 53 patients (23%) presenting with narrow bifurcation (range, 12.5-19.5 mm). Median SLD in these patients was 28 mm, and the SLD/ABD ratio was 1.64. Calcification involving >50% of the bifurcation circumference was present in 32% of the patients, with 17% presenting thrombus in this area. Of 53 patients with narrow bifurcation, intraoperative stenosis >50% occurred in three (5.7%), which required adjunctive treatment. Computed tomography at 1 month showed limb stenosis >50% in nine patients (17%). No limb occlusions were recorded with a median follow-up of 34 months. Multivariate analysis of the overall series showed a higher risk of limb stenosis on the computed tomography at 1 month in patients with peripheral artery disease (hazard ratio [HR], 5.3; 95% confidence interval [CI], 1.2-24.4; P = .032), narrow bifurcation (HR, 5.7; 95% CI, 2-15.8; P = .001), higher SLD/ABD ratio (HR, 29.3; 95% CI, 4-215.2; P = .001), and calcium >50% (HR, 3; 95% CI, 1.1-8; P = .03), and lower in bifurcations with thrombus (HR, 0.3; 95% CI, 0.1-0.8; P = .017).
Abdominal aortic aneurysms with narrow bifurcation can be treated with the bifurcated Excluder device without additional adjunctive measures. The presence of limb stenosis during follow-up is not associated with occlusion. Long-term follow-up studies are needed to confirm these results.
本研究旨在探讨使用 Excluder（W. L. Gore & Associates，Flagstaff，Ariz）分叉支架移植物治疗腹主动脉瘤时，主动脉分叉解剖结构对腔内治疗的影响。
这是一项回顾性单中心研究，纳入了接受 Excluder 支架移植物治疗的患者。分析包括主动脉分叉的解剖学因素（主动脉分叉直径 [ABD]、钙化、血栓）、支架移植物分支的特征（支架移植物分支总直径 [SLD]）和 SLD/ABD 比值。狭窄的分叉定义为 ABD < 20mm。主要结局包括术中狭窄、需要额外的术中措施、分支狭窄和随访期间的闭塞。
该研究纳入了 232 名患者。平均 ABD 为 24.6 ± 6mm，其中 53 名患者（23%）存在狭窄的分叉（范围为 12.5-19.5mm）。这些患者的中位 SLD 为 28mm，SLD/ABD 比值为 1.64。32%的患者存在累及分叉周长>50%的钙化，17%的患者在该区域存在血栓。在 53 名狭窄分叉的患者中，有 3 名（5.7%）发生术中狭窄>50%，需要辅助治疗。1 个月的 CT 检查显示 9 名患者（17%）存在分支狭窄>50%。在中位随访 34 个月时，未记录到分支闭塞。多变量分析显示，外周动脉疾病患者的 1 个月 CT 显示分支狭窄的风险更高（风险比 [HR]，5.3；95%置信区间 [CI]，1.2-24.4；P =.032）、狭窄的分叉（HR，5.7；95% CI，2-15.8；P =.001）、更高的 SLD/ABD 比值（HR，29.3；95% CI，4-215.2；P =.001）和钙>50%（HR，3；95% CI，1.1-8；P =.03），而在存在血栓的分叉中则更低（HR，0.3；95% CI，0.1-0.8；P =.017）。
分叉 Excluder 装置可用于治疗狭窄的分叉腹主动脉瘤，无需额外的辅助措施。随访期间出现分支狭窄与闭塞无关。需要进行长期随访研究来证实这些结果。
