1 Vascular Surgery, University of Bologna "Alma Mater Studiorum," Bologna, Italy.
J Endovasc Ther. 2019 Aug;26(4):550-555. doi: 10.1177/1526602819851251. Epub 2019 May 29.
To evaluate possible predictors of complications with flared iliac stent-graft limbs for ectatic common iliac arteries (CIAs) associated with abdominal aortic aneurysms treated with endovascular aneurysm repair (EVAR). A retrospective comparative analysis was conducted of 533 EVAR patients (mean age 75 years; 442 men) treated between 2012 and 2017 who had complications associated with the stent-graft limbs (n=1066). Complications, including type Ib endoleak, type IIIa endoleak, and limb occlusion, were compared between patients with nondilated (<16 mm) CIAs treated with standard iliac limbs (SLs, n=808) vs patients with ectatic CIAs treated with flared limbs (FLs, n=258). Follow-up included a duplex scan at 3, 6, and 12 months and yearly thereafter; computed tomography angiography was performed in case of iliac complications. Risk factors for iliac complications in FLs were investigated using Cox regression and Kaplan-Meier analyses; results of the regression analysis are presented as the hazard ratio (HR) and 95% confidence interval (CI). Overall, no iliac complications occurred at 30 days, but over a mean follow-up of 38±8 months, there were 10 (1%) events (4 limb occlusions, 6 type Ib endoleaks): 7 (3%) in FLs and 3 (0.4%) in SLs (p=0.20). Kaplan-Meier analysis found no differences at 5 years in SLs vs FLs for freedom from limb occlusion (99%±1% vs 98%±1%, respectively; p=0.30) or type Ib endoleak (96%±3% vs 97%±1%, respectively; p=0.44). Similarly, the overall 5-year iliac complication rates were similar in SLs vs FLs (96%±3% vs 95%±2%, p=0.21). Regression analysis found CIA length ≤30 mm (HR 4.7, 95% CI 1.02 to 21.6, p=0.04) and a diameter ≥20 mm (HR 7.8, 95% CI 1.05 to 64.8, p=0.03) to be independent predictors of iliac complications in FLs. Kaplan-Meier estimates of iliac complication-free survival in FLs were significantly worse when the CIA length was ≤30 mm (79%±9% vs 98%±1%, p=0.003) or the diameter was ≥20 mm (85%±7% vs 99%±1%, p=0.02). The combination of both risk factors produced significantly poorer iliac complication-free survival compared with cases in which there was one or no risk factor (67%±19% vs 96%±2% vs 99%±1%, respectively; p<0.001). Iliac limb complications are infrequent in EVAR, regardless of the type of iliac limb chosen; however, CIAs ≤30 mm in length or ≥20 mm in diameter significantly increased the risk of late iliac complications in FLs. If both characteristics were present, this risk was further elevated.
评估与腹主动脉瘤血管内修复术（EVAR）相关的扩张性髂总动脉（CIA）中喇叭形髂内支架移植物分支并发症的可能预测因素。 对 2012 年至 2017 年间接受治疗的 533 例 EVAR 患者（平均年龄 75 岁；442 例男性）进行了回顾性对比分析，这些患者与支架移植物分支相关的并发症（n=1066）。 在接受标准髂支（SL）治疗的无扩张（<16mm）CIA（n=808）的患者和接受喇叭形支（FL）治疗的扩张性 CIA（n=258）患者之间比较了并发症，包括 Ib 型内漏、IIIa 型内漏和分支闭塞。 随访包括术后 3、6 和 12 个月的双功能超声检查以及此后每年一次；如果发生髂部并发症，则进行计算机断层血管造影。 使用 Cox 回归和 Kaplan-Meier 分析调查了 FL 中髂部并发症的风险因素；回归分析结果以危险比（HR）和 95%置信区间（CI）表示。 总体而言，30 天内无髂部并发症，但在平均 38±8 个月的随访中，有 10 例（1%）发生了事件（4 例分支闭塞，6 例 Ib 型内漏）：FL 中有 7 例（3%），SL 中有 3 例（0.4%）（p=0.20）。Kaplan-Meier 分析发现，在 5 年内，FL 组和 SL 组在分支闭塞的无闭塞率（分别为 99%±1%和 98%±1%；p=0.30）或 Ib 型内漏（分别为 96%±3%和 97%±1%；p=0.44）方面无差异。 同样，在 SL 组和 FL 组中，5 年的髂部总并发症发生率相似（分别为 96%±3%和 95%±2%；p=0.21）。 回归分析发现，CIA 长度≤30mm（HR 4.7，95%CI 1.02-21.6，p=0.04）和直径≥20mm（HR 7.8，95%CI 1.05-64.8，p=0.03）是 FL 中髂部并发症的独立预测因素。 Kaplan-Meier 估计，在 CIA 长度≤30mm（79%±9%vs.98%±1%，p=0.003）或直径≥20mm（85%±7%vs.99%±1%，p=0.02）的患者中，FL 组的髂部无并发症生存率显著较差。 与存在一个或没有风险因素的病例相比（分别为 67%±19%、96%±2%和 99%±1%；p<0.001），同时存在这两个危险因素的患者的髂部无并发症生存率明显较差。 无论选择哪种类型的髂内支，EVAR 中髂支并发症均不常见；然而，CIA 长度≤30mm 或直径≥20mm 显著增加了 FL 中晚期髂部并发症的风险。 如果存在这两种特征，则风险会进一步升高。
