St. George's Vascular Institute, St. George's Hospital, London, United Kingdom.
St. George's Vascular Institute, St. George's Hospital, London, United Kingdom.
J Vasc Surg. 2019 Jan;69(1):53-62.e1. doi: 10.1016/j.jvs.2018.04.016. Epub 2018 May 24.
Endovascular aneurysm sealing (EVAS) represents a novel approach to the treatment of abdominal aortic aneurysms. It uses polymer technology to achieve an anatomic seal within the sac of the aneurysm. This cohort study reports the early clinical outcomes, technical refinements, and learning curve during the initial EVAS experience at a single institution.
Results from 150 consecutive EVAS cases for intact, infrarenal abdominal aortic aneurysms are reported here. These cases were undertaken between March 2013 and July 2015. Preoperative, perioperative, and postoperative data were collected for each patient prospectively.
The median age of the cohort was 76.6 years (interquartile range, 70.2-80.9 years), and 87.3% were male. Median aneurysm diameter was 62.0 mm (IQR, 58.0-69.0 mm). Adverse neck morphology was seen in 69 (46.0%) patients, including aneurysm neck length <10 mm (17.3%), neck diameter >32 mm or <18 mm (8.7%), and neck angulation >60 degrees (15.3%). Median follow-up was 687 days (IQR, 463-897 days); 37 patients (24.7%) underwent reintervention. The rates of unresolved endoleak are 1.3% type IA, 0.7% type IB, and 2.7% type I. There were no type III endoleaks. There have been seven secondary ruptures in this cohort; all but one of these patients survived after reintervention. Only one rupture occurred in an aneurysm that had been treated within the manufacturer's instructions for use (IFU).
The rate of unresolved endoleaks is satisfactorily low. The incidence of secondary rupture is of concern; however, when the IFU are adhered to, the rate is very low. The results of this study suggest that working within the IFU yields better clinical results.
血管内动脉瘤封闭术（EVAS）是一种治疗腹主动脉瘤的新方法。它使用聚合物技术在动脉瘤囊内实现解剖学密封。本队列研究报告了在单一机构的初始 EVAS 经验中的早期临床结果、技术改进和学习曲线。
报告了 150 例连续的 EVAS 病例，用于完整的、肾下腹部主动脉瘤。这些病例发生在 2013 年 3 月至 2015 年 7 月之间。前瞻性地收集每位患者的术前、围手术期和术后数据。
队列的中位年龄为 76.6 岁（四分位距，70.2-80.9 岁），87.3%为男性。中位动脉瘤直径为 62.0 毫米（四分位距，58.0-69.0 毫米）。69 例（46.0%）患者存在不良颈部形态，包括动脉瘤颈部长度<10 毫米（17.3%）、颈部直径>32 毫米或<18 毫米（8.7%）以及颈部成角>60 度（15.3%）。中位随访时间为 687 天（四分位距，463-897 天）；37 例（24.7%）患者再次介入。未解决的内漏率为 1.3% 型 IA、0.7% 型 IB 和 2.7% 型 I。无 III 型内漏。该队列中有 7 例二次破裂；除 1 例外，所有患者经再次介入治疗后均存活。只有 1 例破裂发生在一个符合制造商使用说明（IFU）的动脉瘤中。
未解决的内漏率较低。二次破裂的发生率令人担忧；然而，当遵循 IFU 时，破裂的发生率非常低。本研究结果表明，在 IFU 范围内操作可获得更好的临床结果。
