Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Hellenic Pasteur Institute, Athens, Greece.
J Endovasc Ther. 2019 Oct;26(5):697-703. doi: 10.1177/1526602819861747. Epub 2019 Jul 8.
To evaluate chimney stent-graft position and morphological changes of the aneurysm sac as visualized by postoperative computed tomography angiography (CTA) over a minimum 24-month follow-up period. Twenty-one patients (mean age 75.7±8.6 years; 20 men) with juxtarenal aortic aneurysms who underwent successful chimney endovascular aneurysm repair (ch-EVAR) with the Endurant stent-graft and had 2 postoperative CTAs separated by at least 24 months were included in the study. CTA-based measurements of aortic stent-graft migration, target vessel angle, and chimney angle were compared between the serial scans. During a mean follow-up of 34.9 months (range 24-69.2), the mean migration of the aortic stent-grafts was under 5 mm (2.76±2.4 mm). The average migration distance per year was 1.15 mm. The aneurysm diameter reduced a mean 3.25 mm (p=0.048). The right renal artery angle moved significantly upward 6.72° (p=0.025), while the right renal chimney stent-graft moved significantly downward 7.83° (p=0.042). The left renal artery angle also moved upward 1.87° (p=0.388) and the corresponding chimney moved downward 5.68° (p=0.133). During the study period, no type I/III endoleak or chimney occlusion was observed. Midterm morphometric assessment of ch-EVAR using CTA showed significant aneurysm sac shrinkage and a stable 3-year position of the abdominal devices, with the mean downward migration of the aortic stent-graft being <5 mm in the majority of cases. The chimney grafts seem to be prone to take an oblique rather than parallel configuration during follow-up. However, there was no relevant clinical consequence related to this phenomenon.
评估烟囱支架移植物的位置和形态变化，以及术后 CT 血管造影（CTA）在至少 24 个月的随访期间对动脉瘤囊的显示。 本研究纳入 21 例（平均年龄 75.7±8.6 岁；20 例男性）接受成功的 Endurant 支架移植物烟囱腔内血管修复术（ch-EVAR）治疗的肾周主动脉瘤患者，这些患者至少进行了 2 次术后 CTA 检查，且两次检查之间至少间隔 24 个月。比较了两次扫描之间主动脉支架移植物迁移、靶血管角度和烟囱角度的 CTA 测量值。 在平均 34.9 个月（24-69.2）的随访期间，主动脉支架移植物的平均迁移距离小于 5 毫米（2.76±2.4 毫米）。每年平均迁移距离为 1.15 毫米。动脉瘤直径平均减少 3.25 毫米（p=0.048）。右肾动脉角度向上显著移动 6.72°（p=0.025），而右肾烟囱支架移植物向下显著移动 7.83°（p=0.042）。左肾动脉角度也向上移动 1.87°（p=0.388），相应的烟囱移植物向下移动 5.68°（p=0.133）。在研究期间，未观察到 I/III 型内漏或烟囱闭塞。 使用 CTA 对 ch-EVAR 进行中期形态学评估显示，动脉瘤囊显著缩小，腹部装置在 3 年内保持稳定位置，大多数情况下主动脉支架移植物的平均向下迁移小于 5 毫米。在随访期间，烟囱移植物似乎更容易呈倾斜而不是平行的形态。然而，这种现象没有相关的临床后果。
