Spanos Konstantinos, Kouvelos George, Kontopodis Nikolaos, Ioannou Christos V, Matsagkas Miltiadis, Giannoukas Athanasios D
Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Ann Vasc Surg. 2019 Nov;61:341-349. doi: 10.1016/j.avsg.2019.05.048. Epub 2019 Aug 5.
Remodeling of suprarenal aorta after endovascular aortic aneurysm repair (EVAR) in relation to different endograft designs has not been thoroughly investigated. The aim of this study is to assess the anatomical configuration of the suprarenal aorta after using endografts with different proximal fixation during the first post-EVAR year.
A retrospective study including EVAR patients using 3 types of endografts with different proximal fixation systems according to Instructions for Use was undertaken (50: Ovation, Endologix, Irvin, CA; 25: Endurant IIs, Medtronic, Santa Rosa, CA; 25: Excluder C3, W. L. Gore & Associates, Flagstaff, AZ). Comorbidities were recorded. Anatomic variables of the supra-aortic anatomy, abdominal aortic aneurysm (AAA) maximum diameter, and neck angulation were analyzed. Computed tomography angiography was obtained preoperatively at 1 and 12 months post-EVAR, while a duplex scan was undertaken at 6 months.
Comorbidities were not different across the 3 groups. Presence and amount of neck calcification (P = 0.139) and thrombus (P = 0.116) was similar among groups. Maximum aortic diameter showed significant reduction from preoperative measurements to 12-month postoperative ones, for all groups. (Ovation: 56.5 to 53 mm, P < 0.001; Endurant: 57 to 51 mm, P < 0.001; Excluder: 55 to 50 mm, P < 0.001). Suprarenal angulation was decreased significantly in the Ovation (P < 0.001) and Excluder groups (P = 0.05), while the infrarenal angulation was decreased in all groups. Among endografts, the decrease in AAA maximum diameter was similar (P = 0.99), while the suprarenal aortic diameter was significantly increased in Ovation patients in comparison to the other 2 endografts at the level of 5 mm (P = 0.02) and 25 mm (P = 0.01). Suprarenal angulation reduction was similar (P = 0.7), while infrarenal angulation was significantly more decreased in Ovation endograft than the other 2 systems (P < 0.001).
Proximal endograft configuration appears to have different impact on supra-aortic anatomy. Longer follow-up is needed to clarify future remodeling and clinical impact of these observations.
血管腔内修复术（EVAR）后肾上腺上方主动脉的重塑与不同的腔内移植物设计之间的关系尚未得到充分研究。本研究的目的是评估在EVAR术后的第一年使用不同近端固定方式的腔内移植物后肾上腺上方主动脉的解剖结构。
进行一项回顾性研究，纳入根据使用说明书使用3种不同近端固定系统的腔内移植物的EVAR患者（50例：Ovation，Endologix，尔湾，加利福尼亚州；25例：Endurant IIs，美敦力公司，圣罗莎，加利福尼亚州；25例：Excluder C3，W.L.戈尔公司，弗拉格斯塔夫，亚利桑那州）。记录合并症。分析肾上腺上方主动脉解剖结构的解剖学变量、腹主动脉瘤（AAA）最大直径和颈部角度。在EVAR术前、术后1个月和12个月进行计算机断层扫描血管造影，同时在术后6个月进行双功超声扫描。
3组患者的合并症无差异。各组之间颈部钙化的存在和程度（P = 0.139）以及血栓（P = 0.116）相似。所有组的主动脉最大直径从术前测量值到术后12个月均显著减小。（Ovation组：从56.5 mm减小到53 mm，P < 0.001；Endurant组：从57 mm减小到51 mm，P < 0.001；Excluder组：从55 mm减小到50 mm，P < 0.001）。Ovation组（P < 0.001）和Excluder组（P = 0.05）的肾上腺上方角度显著减小，而所有组的肾下角度均减小。在腔内移植物中，AAA最大直径的减小相似（P = 0.99），而在5 mm（P = 0.02）和25 mm（P = 0.01）水平上，与其他2种植入物相比，Ovation患者的肾上腺上方主动脉直径显著增加。肾上腺上方角度减小相似（P = 0.7），而Ovation腔内移植物的肾下角度比其他2种系统显著减小更多（P < 0.001）。
近端腔内移植物结构似乎对肾上腺上方主动脉解剖结构有不同影响。需要更长时间的随访来阐明这些观察结果未来的重塑情况和临床影响。
