Eleshra Ahmed, Saleptsis Vasilis, Spanos Konstantinos, Rohlffs Fiona, Tsilimparis Nikolaos, Panuccio Giuseppe, Makaloski Vladimir, Debus Eike Sebastian, Kölbel Tilo
Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg, Hamburg, Germany.
Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg, Hamburg, Germany.
Ann Vasc Surg. 2019 Nov;61:310-316. doi: 10.1016/j.avsg.2019.05.019. Epub 2019 Aug 2.
Presence of gas is a frequent finding on early postoperative computed tomography angiography (CTA) after endovascular aortic aneurysm repair (EVAR) with unclear clinical relevance. The aim of this study is to examine and compare the presence of gas within the aneurysm sac following EVAR on early postoperative CTA after the use of carbon dioxide (CO) flushing technique with saline flushing alone.
A retrospective analysis of patients undergoing standard, fenestrated EVAR (fEVAR) or branched EVAR (bEVAR) with flushing of the delivery system with CO between January 2016 and August 2018 was undertaken. Data of a previous report using standard saline flushing were included. Patients were classified into 2 main groups: group 1 with saline flushing and group 2 with CO flushing and 3 subgroups according to the type of endograft. The presence, position, and volume of gas in the postoperative CTA (within 10 days) was examined and analyzed in terms of anatomical and procedural risk factors.
Group 1 included 210 patients (mean age 73 ± 8, 84% males), while group 2 included 300 patients (mean age 70 ± 11, 68% males). Presence of gas was more common in group 1 (83, 39% vs. 64, 21%, P = 0.000). Volume of gas was larger in group 1 [0.41 mL (0.01-2.7) vs. 0.2 mL (0.02-1), P = 0.001). In standard EVAR with saline flushing (subgroup 1a), 59 patients (45%) had presence of gas with CO flushing (subgroup 2a); 35 patients (25%) had presence of gas (P = 0.005). The mean gas volume was larger in subgroup 1a compared to 2a (0.40 ± 0.47 vs. 0.15 ± 0.17 mL, P = 0.000). The location of the gas was more frequent in contact with the anterior wall of the aorta in both groups, standard EVAR subgroups and fEVAR subgroups. The presence of gas in group 2 was associated with larger preoperative size of the aortic diameter (P = 0.03) and larger perfused lumen diameter (P = 0.05). The type of the graft was not associated with the presence of gas in the aneurysm sac on postoperative CTA. However, the presence of gas was more frequent in standard EVAR than fEVAR and bEVAR. Endoleak type II was not associated with the presence of gas.
CO flushing of stent grafts during standard and complex EVAR prior to deployment reduces the frequency and volume of gas on postoperative CTA. This study indicates that the CO flushing technique may effectively exchange trapped air for a less harmful gas in endografts.
在血管内主动脉瘤修复术（EVAR）后的早期术后计算机断层扫描血管造影（CTA）中，气体的存在是常见的发现，但其临床相关性尚不清楚。本研究的目的是检查和比较在使用二氧化碳（CO）冲洗技术与单纯盐水冲洗后，EVAR术后早期CTA上瘤腔内气体的存在情况。
对2016年1月至2018年8月期间接受标准、开窗EVAR（fEVAR）或分支EVAR（bEVAR）并使用CO冲洗输送系统的患者进行回顾性分析。纳入了先前一份使用标准盐水冲洗的报告中的数据。患者分为2个主要组：第1组为盐水冲洗组，第2组为CO冲洗组，并根据腔内移植物类型分为3个亚组。对术后CTA（10天内）中气体的存在、位置和体积进行检查，并根据解剖和手术风险因素进行分析。
第1组包括210例患者（平均年龄73±8岁，84%为男性），而第2组包括300例患者（平均年龄70±11岁，68%为男性）。第1组中气体的存在更为常见（83例，39%对64例，21%，P = 0.000）。第1组中的气体体积更大[0.4ml（0.01 - 2.7）对0.2ml（0.02 - 1），P = 0.001]。在标准EVAR盐水冲洗（亚组1a）中，59例患者（45%）有气体存在，而CO冲洗（亚组2a）中有35例患者（25%）有气体存在（P = 0.005）。与亚组2a相比，亚组1a中的平均气体体积更大（0.40±0.47对0.15±0.17ml，P = 0.000）。在两组、标准EVAR亚组和fEVAR亚组中，气体的位置更常与主动脉前壁接触。第2组中气体的存在与术前主动脉直径较大（P = 0.03）和灌注管腔直径较大（P = 0.05）相关。移植物类型与术后CTA上瘤腔内气体的存在无关。然而，标准EVAR中气体的存在比fEVAR和bEVAR更频繁。II型内漏与气体的存在无关。
在标准和复杂EVAR术前部署期间对支架移植物进行CO冲洗可降低术后CTA上气体的频率和体积。本研究表明，CO冲洗技术可能有效地将被困空气置换为腔内移植物中危害较小的气体。
