Gargiulo Mauro, Gallitto Enrico, Pini Rodolfo, Giordano Jacopo, Mascoli Chiara, Sonetto Alessia, Logiacco Antonino, Ancetti Stefano, Faggioli Gianluca
Unit of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Unit of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy -
J Cardiovasc Surg (Torino). 2020 Feb;61(1):2-9. doi: 10.23736/S0021-9509.19.11185-8. Epub 2019 Dec 13.
The aim of this study was to report early/mid-term-up outcomes of fenestrated endografting (FEVAR) for juxta-renal aneurysms (j-AAAs).
Between 2008 and 2019, all consecutive j-AAAs treated by FEVAR were prospectively collected and retrospectively analyzed. Early endpoints were technical success, renal function worsening and 30-day mortality. Follow-up endpoints were survival, freedom from re-interventions (FFRs) and target visceral vessels (TVVs) patency.
Among 240 cases of FB-EVAR, 98(41%) were j-AAAs. Endografts with 1,2,3,4 and 5 fenestrations were planned in 3(3%), 25(26%), 35(36%), 33(34%) and 2(1%) cases, respectively. Overall, 360 TVVs were treated by fenestrations and scallops. Technical success was achieved in 97(99%) cases. The only failure was 1 type III endoleak requiring renal artery relining. No TVVs were lost. Renal function worsening was reported in 22(22%) and 12(12%) cases at 24-hour and 30-day, respectively. One patient required hemodialysis and died within 30-day (1%). This was the only case of 30-day mortality. The mean follow-up was 36±32months. Aneurysm sac shrinkage or stability was observed in 55(56%) and 41(42%) cases, respectively. Two (2%) patients with persistent type II endoleak had sac enlargement and required re-interventions. Freedom from reinterventions at 5-year was 86%. An asymptomatic celiac trunk occlusion (accommodated by a scallop) occurred at 24-month in a case with a severe preoperative stenosis. No late renal arteries occlusions or type I-III endoleaks occurred. TVVs-patency was 96% at 5-year. Renal function worsening was reported in 10(10%) patients during follow-up. Survival at 5-year was 73%, with no j-AAA related mortality. Chronic obstructive pulmonary disease (COPD) (P=0.007; OR:4.8; 95% CI: 1.5-15.3) and postoperative renal function worsening (P=0.028; OR:1,1; 95% CI: 1.1-1.2) were independent predictor for mortality at the multivariate analysis.
FEVAR for j-AAAs is safe and effective at early and long-term follow-up. According with these results, it could be proposed as the first line treatment in high risk patients if anatomically fit. Long term survival is reduced in the presence of preoperative COPD and postoperative renal function worsening.
本研究的目的是报告开窗腔内修复术（FEVAR）治疗近肾动脉瘤（j-AAAs）的早/中期结果。
2008年至2019年期间，前瞻性收集并回顾性分析所有接受FEVAR治疗的连续性j-AAAs病例。早期终点包括技术成功、肾功能恶化和30天死亡率。随访终点包括生存、免于再次干预（FFRs）和目标内脏血管（TVVs）通畅。
在240例FB-EVAR病例中，98例（41%）为j-AAAs。分别有3例（3%）、25例（26%）、35例（36%）、33例（34%）和2例（1%）病例计划使用1、2、3、4和5个开窗的腔内移植物。总体而言，360条TVVs通过开窗和扇贝形技术进行了治疗。97例（99%）病例实现了技术成功。唯一的失败病例是1例III型内漏，需要进行肾动脉内衬。没有TVVs丢失。分别有22例（22%）和12例（12%）病例在术后24小时和30天时出现肾功能恶化。1例患者需要进行血液透析，并在30天内死亡（1%）。这是唯一的30天死亡病例。平均随访时间为36±32个月。分别有55例（56%）和41例（42%）病例观察到动脉瘤囊缩小或稳定。2例（2%）持续性II型内漏患者出现囊腔扩大，需要再次干预。5年时免于再次干预的比例为86%。1例术前严重狭窄的病例在术后24个月出现无症状的腹腔干闭塞（通过扇贝形技术处理）。没有发生晚期肾动脉闭塞或I-III型内漏。5年时TVVs通畅率为96%。随访期间有10例（10%）患者出现肾功能恶化。5年生存率为73%，没有与j-AAAs相关的死亡。慢性阻塞性肺疾病（COPD）（P=0.007；OR：4.8；95%CI：1.5-15.3）和术后肾功能恶化（P=0.028；OR：1.1；95%CI：1.1-1.2）是多变量分析中死亡率的独立预测因素。
FEVAR治疗j-AAAs在早期和长期随访中是安全有效的。根据这些结果，如果解剖结构合适，对于高危患者可将其作为一线治疗方法。术前存在COPD和术后肾功能恶化会降低长期生存率。
