Lee Jae Hoon, Park Ki Hyuk
Division of Vascular and Endovascular Surgery, Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea.
Vasc Specialist Int. 2017 Jun;33(2):59-64. doi: 10.5758/vsi.2017.33.2.59. Epub 2017 Jun 30.
Cone shape neck is regarded as non-instruction for use (IFU) in most commercial stent graft. However, in real practice, liberal application of endovascular aneurysm repair (EVAR) for outside of IFU happens. We investigate non-adherence to conical neck anatomy in terms of early aneurysmal exclusion results.
From January 2010 to December 2013, 105 patients with abdominal aortic aneurysm (AAA) underwent EVAR in Daegu Catholic University Medical Center. Among them, 38 patients (36.2%) had AAA with conical neck. We investigated the clinical characteristics of patients and the details of conical neck. We also analyzed the clinical results, such as endoleak, migration, procedure failure, perioperative mortality, and admission duration between conical neck and non-conical neck.
The maximum diameter of AAA was larger (60.95 mm vs. 52.68 mm, P=0.016) and the infrarenal neck length was shorter (25.07 mm vs. 38.13 mm, P=0.000) in conical neck group. During the procedure, type Ia endoleak occurred more in conical neck group (23.7% vs. 6.0%, P=0.013) and it could be successfully solved with additional adjunctive treatments, such as balloon or Palmaz stent. Although there was no statistical significance, mortality was higher and admission duration was longer in the conical neck (15.8% vs. 6.0%, 16.62±13.12 days vs. 13.03±13.13 days). Mean follow-up duration was 319.2±366.45 days. Successful aneurysmal exclusion was achieved.
The presence of conical neck may not be a contraindication for EVAR. However, conical neck requires careful observation for additional adjunctive treatments because it increases the risk of type Ia endoleak.
在大多数商用覆膜支架中，锥形颈部被视为使用说明（IFU）之外的情况。然而，在实际操作中，血管内动脉瘤修复术（EVAR）在IFU范围外被广泛应用。我们根据早期动脉瘤排除结果，研究对锥形颈部解剖结构的不依从性。
2010年1月至2013年12月，105例腹主动脉瘤（AAA）患者在大邱天主教大学医学中心接受了EVAR治疗。其中，38例（36.2%）患者的AAA具有锥形颈部。我们调查了患者的临床特征和锥形颈部的详细情况。我们还分析了临床结果，如内漏、移位、手术失败、围手术期死亡率以及锥形颈部和非锥形颈部之间的住院时间。
锥形颈部组的AAA最大直径更大（60.95 mm对52.68 mm，P=0.016），肾下颈部长度更短（25.07 mm对38.13 mm，P=0.000）。在手术过程中，Ia型内漏在锥形颈部组中发生得更多（23.7%对6.0%，P=0.013），并且可以通过额外的辅助治疗，如球囊或帕尔马兹支架成功解决。尽管没有统计学意义，但锥形颈部组的死亡率更高，住院时间更长（15.8%对6.0%，16.62±13.12天对13.03±13.13天）。平均随访时间为319.2±366.45天。成功实现了动脉瘤的排除。
锥形颈部的存在可能不是EVAR的禁忌症。然而，由于锥形颈部会增加Ia型内漏的风险，因此需要仔细观察并进行额外的辅助治疗。
