Reyes Valdivia Andrés, Álvarez Marcos Francisco, Duque Santos África, Ocaña Guaita Julia, Gandarias Zúñiga Claudio
1 Department of Vascular and Endovascular Surgery, Ramón y Cajal University Hospital, Madrid, Spain.
2 Department of Vascular and Endovascular Surgery, Complexo Hospitalario A Coruña, Spain.
J Endovasc Ther. 2019 Apr;26(2):245-249. doi: 10.1177/1526602819828377. Epub 2019 Feb 1.
To assess if the suitability of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs) can be expanded by combining the Endurant stent-graft with the Heli-FX EndoAnchors.
Contrast-enhanced computed tomography (CT) scans of 90 patients (mean age 73.2±9 years; 87 men) with RAAA admitted between January 2014 and January 2018 in 2 tertiary care centers were analyzed in a 3-dimensional workstation. Anatomical features of the aneurysms according to the instructions for use (IFU) for the Endurant endograft were evaluated and expansion of treatment with Heli-FX EndoAnchors was assessed.
Neck length <10 mm was present in 41 (45.6%) patients; 5 had neck diameters outside the IFU and 45 (50.0%) had conical necks. Thrombus and calcium were absent in 63 (70.0%) and 73 (81.1%), respectively. In the study cohort, 44 (48.9%) patients met all the neck criteria, although overall IFU compliance was found in only 35 (38.9%) patients due to iliac-related issues in 21 patients. The adjunctive use of EndoAnchors in the entire study group would enhance the therapeutic range to an additional 24 patients, 8 of whom would need an associated iliac procedure. This represents an expansion of the total EVAR approach from 48.9% to 75.6% of cases if some iliac issues are overcome and from 38.9% to 56.7% without correcting iliac deficiencies.
The main reason of being unfit for endovascular treatment in this series was neck length <10 mm. Based on this analysis, nearly 40% of RAAA patients would have been candidates for EVAR based on the IFU neck criteria for the Endurant stent-graft. This suitability could be nearly doubled with the use of EndoAnchors and correction of unsuitable iliac anatomy. The use of EndoAnchors has the potential to offer a significant benefit in the endovascular treatment of RAAA patients.
评估通过将Endurant覆膜支架与Heli-FX内固定器相结合，能否扩大破裂腹主动脉瘤（RAAA）的血管内动脉瘤修复术（EVAR）的适用范围。
在一个三维工作站中分析了2014年1月至2018年1月期间在2家三级医疗中心收治的90例RAAA患者（平均年龄73.2±9岁；87例男性）的增强计算机断层扫描（CT）图像。根据Endurant腔内移植物的使用说明书（IFU）评估动脉瘤的解剖特征，并评估使用Heli-FX内固定器扩大治疗范围的情况。
41例（45.6%）患者的瘤颈长度<10 mm；5例患者的瘤颈直径超出IFU范围，45例（50.0%）患者的瘤颈呈锥形。分别有63例（70.0%）和73例（81.1%）患者无血栓和钙化。在研究队列中，44例（48.9%）患者符合所有瘤颈标准，尽管由于21例患者存在髂血管相关问题，总体IFU符合率仅为35例（38.9%）。在整个研究组中辅助使用内固定器将使治疗范围再增加24例患者，其中8例患者需要进行相关的髂血管手术。如果克服一些髂血管问题，这将使EVAR治疗的总适用率从48.9%扩大到75.6%；如果不纠正髂血管缺陷，则从38.9%扩大到56.7%。
本系列中不适合血管内治疗的主要原因是瘤颈长度<10 mm。基于此分析，根据Endurant覆膜支架的IFU瘤颈标准，近40%的RAAA患者可能适合EVAR治疗。通过使用内固定器和纠正不合适的髂血管解剖结构，这种适用性可能会增加近一倍。使用内固定器有可能为RAAA患者的血管内治疗带来显著益处。
