1 Division of Vascular Surgery, "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy.
J Endovasc Ther. 2018 Apr;25(2):230-236. doi: 10.1177/1526602817752449. Epub 2018 Jan 9.
To evaluate the 1-year outcomes of thoracoabdominal aortic aneurysm (TAAA) repair using fenestrated and branched stent-grafts and a novel balloon-expandable covered stent.
Between March 2015 and January 2017, 18 patients (median age 74.7 years; 14 men) received 43 LifeStream balloon-expandable covered stents in conjunction with Zenith fenestrated/branched stent-grafts to bridge 11 celiac trunks, 8 superior mesenteric arteries, and 24 renal arteries (total 32 fenestrations and 11 branches).
Stent delivery and deployment was successful in all cases. At 30 days, 5 patients presented with perifenestration endoleaks (type IIIc) secondary to inadequate sealing of the LifeStream covered stent in 7 (22%) of 32 fenestrations. No type IIIc endoleaks were reported in the branched cases. Four patients had a secondary endovascular reintervention with proximal relining by means of a bare balloon-expandable stent at the perifenestration transition area, with complete resolution of the endoleak at 1-year follow-up. One patient refused reintervention. The last 4 fenestrated stent-grafts of this series had prophylactic perifenestration bare stent relining with no evidence of type IIIc endoleaks at imaging. At a median follow-up of 14.1 months (interquartile range 11, 22), the 12-month LifeStream patency rate was 100%.
This single-center preliminary experience with the LifeStream balloon-expandable covered stent in fenestrated/branched stent-grafts for TAAA repairs demonstrated good patency; however, an unexpectedly high rate of type IIIc endoleaks was observed. These endoleaks were resolved with reintervention or during the index procedure by proximal relining with a bare balloon-expandable stent, achieving adequate perifenestration sealing.
评估使用开窗和分支支架及新型球囊扩张覆膜支架治疗胸腹主动脉瘤（TAAA）的 1 年结果。
2015 年 3 月至 2017 年 1 月，18 例患者（中位年龄 74.7 岁；14 例男性）接受 43 个 LifeStream 球囊扩张覆膜支架与 Zenith 开窗/分支支架联合治疗，共吻合 11 个腹腔干、8 个肠系膜上动脉和 24 个肾动脉（共 32 个开窗和 11 个分支）。
所有病例均成功完成支架输送和释放。30 天时，5 例患者（22%）的 7 个（22%）开窗处出现 LifeStream 覆膜支架覆盖不全的边缘漏（IIIc 型）。分支病例无 IIIc 型边缘漏。4 例患者因边缘漏在边缘过渡区进行近端覆膜支架再次腔内修复，1 年随访时漏口完全消失。1 例患者拒绝再次介入治疗。该系列的最后 4 个开窗支架均预防性地在边缘覆膜支架上进行边缘裸支架再衬，影像学检查未见 IIIc 型边缘漏。中位随访 14.1 个月（四分位距 11，22），12 个月时 LifeStream 通畅率为 100%。
本单中心初步经验显示，在 TAAA 修复中使用 LifeStream 球囊扩张覆膜支架与开窗和分支支架联合治疗具有良好的通畅性；然而，观察到 IIIc 型边缘漏的发生率出乎意料地高。这些边缘漏通过再次介入治疗或在指数手术期间通过近端裸球囊扩张支架再衬得到解决，实现了足够的边缘漏封闭。
