de Blic Romain, Cochennec Frédéric, Alomran Faris, Kobeiter Hicham, Allaire Eric, Desgranges Pascal, Becquemin Jean-Pierre
Department of Vascular Surgery, Henri Mondor Hospital, University Paris-Est Créteil, Créteil, France.
Department of Vascular Surgery, Henri Mondor Hospital, University Paris-Est Créteil, Créteil, France.
Ann Vasc Surg. 2018 Aug;51:200-206. doi: 10.1016/j.avsg.2018.02.040. Epub 2018 Jun 19.
The aim of this retrospective study was to examine the impact of graft oversizing on gutter area and stent compression in chimney graft (CG) for complex abdominal aortic aneurysm (CAAA) repair. The influence of stent-graft oversizing on type Ia endoleaks and bridging stent occlusion rates was also examined.
Preoperative and postoperative computed tomographic angiography scans of patients requiring CGs for CAAA between June 2009 and April 2013 in our institution were analyzed. Two groups were identified: proximal oversizing of the stent-graft component < 25% (group 1) and >25% (group 2). Relative gutter areas were calculated and compared between both groups. Incidence of target vessel stent compression, target vessel occlusions, and type Ia endoleaks was also analyzed.
Of 39 patients treated with CG during the study period, 23 fulfilled the selection criteria for analysis. Group 1 included 10 patients and group 2 included 13 patients (mean oversizing: 18.4 ± 4.9% and 34.5 ± 6% respectively). Relative gutter areas were significantly higher in group 1 when compared with group 2 (6.1 ± 2.1% vs. 4.2 ± 3.2%, P = 0.03). No stent compression and no target vessel occlusion occurred in either groups. There was no statistical difference in type Ia endoleak in both groups (group 1 n = 0, group 2 n = 2; P = 0.48).
In our study, a >25% stent-graft oversizing reduced the gutter area without modifying the bridging stent patency. However, no benefit in terms of type Ia endoleak was observed.
本回顾性研究的目的是探讨移植物尺寸过大对复杂腹主动脉瘤（CAAA）修复中烟囱移植物（CG）的沟隙面积和支架压缩的影响。同时也研究了覆膜支架尺寸过大对Ia型内漏和桥接支架闭塞率的影响。
分析了2009年6月至2013年4月在我院因CAAA需要CG治疗的患者的术前和术后计算机断层血管造影扫描。确定了两组：覆膜支架组件近端尺寸过大<25%（第1组）和>25%（第2组）。计算并比较两组的相对沟隙面积。还分析了靶血管支架压缩、靶血管闭塞和Ia型内漏的发生率。
在研究期间接受CG治疗的39例患者中，23例符合分析的选择标准。第1组包括10例患者，第2组包括13例患者（平均尺寸过大分别为18.4±4.9%和34.5±6%）。与第2组相比，第1组的相对沟隙面积显著更高（6.1±2.1%对4.2±3.2%，P=0.03）。两组均未发生支架压缩和靶血管闭塞。两组Ia型内漏无统计学差异（第1组n=0，第2组n=2；P=0.48）。
在我们的研究中，覆膜支架尺寸过大>25%会减小沟隙面积，而不改变桥接支架的通畅性。然而，在Ia型内漏方面未观察到益处。
