Tsilimparis Nikolaos, Heidemann Franziska, Rohlffs Fiona, Diener Holger, Wipper Sabine, Debus E Sebastian, Kölbel Tilo
1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center of Hamburg, Germany.
J Endovasc Ther. 2017 Dec;24(6):825-832. doi: 10.1177/1526602817729673. Epub 2017 Sep 6.
To analyze the outcome of surgeon-modified fenestrated and branched stent-grafts (sm-FBSG) in high-risk patients with symptomatic complex aortic pathology or contained rupture.
A single-center retrospective analysis was conducted of 21 consecutive patients (mean age 70 years, range 58-87; 16 men) treated with a sm-FBSG from April 2014 to September 2016. The indications included 11 thoracoabdominal and 10 pararenal aortic pathologies, which presented as symptomatic in 8 and as contained rupture in 13 patients. The mean aneurysm diameter was 7.4±2.3 cm.
Technical success was 100%. From 1 to 4 (mean 3) renovisceral branch vessels were targeted with fenestrations. The mean length of in-hospital stay was 19 days (range 1-78). There was 1 death within 30 days and 2 further in-hospital deaths. Two patients suffered permanent spinal cord injury, 2 developed respiratory failure, and 2 had renal failure requiring temporary or permanent dialysis. No myocardial infarction, stroke, or bowel ischemia occurred. Six early endoleaks (3 type II and 3 minor type III) were detected. Mean follow-up was 11.2 months (range 2-33) in 17 patients. One late aneurysm-related death occurred. All 13 follow-up imaging studies showed patent target renovisceral vessels, with 1 type I and 2 type II endoleaks.
Sm-FBSG can be utilized for urgent treatment of complex abdominal and thoracoabdominal aortic pathologies in high-risk patients with anatomy unsuitable for commercially available stent-grafts.
分析外科改良开窗及分支型覆膜支架移植物（sm-FBSG）在有症状的复杂主动脉病变或局限性破裂的高危患者中的治疗效果。
对2014年4月至2016年9月间连续接受sm-FBSG治疗的21例患者（平均年龄70岁，范围58 - 87岁；16例男性）进行单中心回顾性分析。适应证包括11例胸腹主动脉病变和10例肾旁主动脉病变；其中8例有症状，13例为局限性破裂。动脉瘤平均直径为7.4±2.3 cm。
技术成功率为100%。开窗定位1至4支（平均3支）肾血管分支。平均住院时间为19天（范围1 - 78天）。30天内死亡1例，住院期间另有2例死亡。2例患者发生永久性脊髓损伤，2例出现呼吸衰竭，2例出现肾衰竭需临时或永久透析。未发生心肌梗死、中风或肠缺血。检测到6例早期内漏（3例II型和3例轻微III型）。17例患者平均随访11.2个月（范围2 - 33个月）。发生1例晚期动脉瘤相关死亡。所有13次随访影像学检查显示目标肾血管分支通畅，有1例I型和2例II型内漏。
对于解剖结构不适合使用市售覆膜支架移植物的高危患者，sm-FBSG可用于紧急治疗复杂的腹主动脉和胸腹主动脉病变。
