Veraldi Gian Franco, Mezzetto Luca, Vaccher Filippo, Scorsone Lorenzo, Bonvini Stefano, Raunig Igor, Wassermann Valentina, Tasselli Sebastiano
Department of Vascular Surgery, University Hospital of Verona, Polo Confortini, Verona, Italy.
Department of Vascular Surgery, University Hospital of Verona, Polo Confortini, Verona, Italy.
Ann Vasc Surg. 2018 Oct;52:57-66. doi: 10.1016/j.avsg.2018.03.025. Epub 2018 May 18.
This study aims at evaluating technical success and long-term results using Gore Excluder/C3 endoprosthesis in patients with narrow aortic bifurcation (NAB; inner aortic diameter < 18 mm).
Clinical and anatomical data were collected retrospectively from patients treated in 2 high-volume Italian vascular centers between 2005 and 2017. A total of 1325 endovascular aneurysm repair procedures were performed, of which 195 involved Excluder/C3 Gore endoprosthesis. One hundred forty-one patients had a regular aortic bifurcation (RAB; maximum inner diameter ≥ 18 mm), whereas 54 presented with NAB (<18 mm). Technical success and procedural time were considered as primary outcomes. Secondary outcomes were perioperative complications, long-term graft-related complications and reintervention rates.
Demographic data and risk factors were similar in the 2 groups. The mean diameter of aortic bifurcation was 29.8 ± 10.4 mm in RAB versus 17.1 ± 0.9 mm in NAB. Technical success was 100% in both groups. Incidence of intraoperative kinking/stenosis of limb graft was significantly higher in NAB (40.7% vs. 12.8%; P < 0.001), which was treated by means of kissing balloon technique (KiBaTe) and selective stenting. Time of procedure was similar. Post-operative complications rate was similar in both the groups (9.5% in RAB versus 4.2% in NAB, P = 0.180). Mean follow-up period was 40.0 months (range, 1-130). No significant difference was registered in long-term graft-related complications between RAB and NAB (38.3% vs. 38.8%; P = 0.939). Reintervention rate after 70 months was 21.8% vs. 24.6% in RAB and NAB, respectively (log rank = 0.517). Primary patency at 6, 12, and 48 months was 99.3% vs. 100%, 99.3% vs. 100%, and 98.5% vs. 97.9%, respectively (log rank = 0.497). Assisted primary patency was 98.6% vs. 96.0%, 97.8% vs. 96.0%, and 97.8% vs. 96.0%, respectively (log rank = 0.789). Secondary patency was 100% in both the groups.
Endovascular aneurysm repair of NAB using Gore Excluder/C3 graft can be considered safe and effective in early and late follow-up. Intraoperative graft kinking is frequent in NAB and KiBaTe is recommended to prevent occlusive complications.
本研究旨在评估使用戈尔Excluder/C3血管内假体治疗主动脉分叉狭窄（NAB；主动脉内径<18mm）患者的技术成功率和长期疗效。
回顾性收集2005年至2017年期间在2家大型意大利血管中心接受治疗的患者的临床和解剖学数据。共进行了1325例血管内动脉瘤修复手术，其中195例使用了Excluder/C3戈尔血管内假体。141例患者主动脉分叉正常（RAB；最大内径≥18mm），而54例表现为NAB（<18mm）。技术成功率和手术时间被视为主要结局。次要结局包括围手术期并发症、长期移植物相关并发症和再次干预率。
两组的人口统计学数据和危险因素相似。RAB组主动脉分叉的平均直径为29.8±10.4mm，而NAB组为17.1±0.9mm。两组的技术成功率均为100%。NAB组肢体移植物术中扭结/狭窄的发生率显著高于RAB组（40.7%对12.8%；P<0.001），采用球囊扩张技术（KiBaTe）和选择性支架置入术进行治疗。手术时间相似。两组的术后并发症发生率相似（RAB组为9.5%，NAB组为4.2%，P=0.180）。平均随访期为40.0个月（范围1-130个月）。RAB组和NAB组在长期移植物相关并发症方面无显著差异（38.3%对38.8%；P=0.939）。70个月后的再次干预率在RAB组和NAB组分别为21.8%和24.6%（对数秩检验=0.517）。6个月、12个月和48个月时的原发性通畅率分别为99.3%对100%、99.3%对100%和98.5%对97.9%（对数秩检验=0.497）。辅助原发性通畅率分别为98.6%对96.0%、97.8%对96.0%和97.8%对96.0%（对数秩检验=0.789）。两组的继发性通畅率均为100%。
使用戈尔Excluder/C3移植物对NAB进行血管内动脉瘤修复在早期和晚期随访中可被认为是安全有效的。NAB术中移植物扭结很常见，建议采用KiBaTe预防闭塞性并发症。
