Peters Andreas S, Hatzl Johannes, Bischoff Moritz S, Böckler Dittmar
Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany -
J Cardiovasc Surg (Torino). 2020 Feb;61(1):67-72. doi: 10.23736/S0021-9509.18.10206-0. Epub 2018 Apr 3.
Due to recent advances in endograft design and percutaneous access, technical success could be increased during endovascular aneurysm repair (EVAR). Beside EVAR, endovascular aneurysm sealing (EVAS) provides an alternative procedure to treat aneurysms. To compare the two methods, additional benchmark criteria should be evaluated: Screening time, dose area product (DAP), procedure time and contrast use. In this study these technical variables are analyzed for EVAS vs. EVAR in comparable patient cohorts.
It is a retrospective, single-center study. Only elective cases of infrarenal aortic aneurysms were included, all treated by the same surgeon (D.B.). Procedures were performed within the instructions for use without additional procedures. All operations were undertaken in a hybrid operating theatre. For EVAR, only the Medtronic Endurant® and the Gore C3 Excluder® were included. For EVAS the Nellix® from Endologix was used.
Between 2012 and 2016, 67 patients were treated with EVAS and 40 with EVAR; of these 20 and 16 could be introduced into the study respectively. Median age was 73 and 72 years respectively (only men). The two groups were comparable in terms of BMI, GFR and ASA-status. Screening time was reduced for EVAS (10.6 vs. 14.5 min., P<0.01), while the DAP was not significantly different. Procedural time and contrast use were increased for EVAS (120 vs. 96 min., 120 vs. 79 mL, P<0.01).
Especially the younger EVAS-procedure requires ongoing review in order to further reduce contrast agent. Reduced screening time for EVAS does not have a significant impact on radiation dose.
由于近期腔内移植物设计和经皮穿刺技术的进展，血管内动脉瘤修复术（EVAR）的技术成功率得以提高。除了EVAR，血管内动脉瘤封堵术（EVAS）为治疗动脉瘤提供了另一种方法。为比较这两种方法，应评估其他基准标准：筛查时间、剂量面积乘积（DAP）、手术时间和造影剂用量。在本研究中，对可比患者队列中EVAS与EVAR的这些技术变量进行了分析。
这是一项回顾性单中心研究。仅纳入肾下腹主动脉瘤择期病例，均由同一外科医生（D.B.）进行治疗。手术按照使用说明书进行，无额外操作。所有手术均在复合手术室进行。对于EVAR，仅纳入美敦力Endurant®和戈尔C3 Excluder®。对于EVAS，使用了英诺洛基公司的Nellix®。
2012年至2016年期间，67例患者接受了EVAS治疗，40例接受了EVAR治疗；其中分别有20例和16例可纳入本研究。中位年龄分别为73岁和72岁（仅男性）。两组在体重指数、肾小球滤过率和美国麻醉医师协会（ASA）分级方面具有可比性。EVAS的筛查时间缩短（10.6分钟对14.5分钟，P<0.01），而DAP无显著差异。EVAS的手术时间和造影剂用量增加（120分钟对96分钟，120毫升对79毫升，P<0.01）。
特别是较年轻患者的EVAS手术需要持续评估，以进一步减少造影剂用量。EVAS筛查时间的缩短对辐射剂量无显著影响。
