Silverberg Daniel, Aburamileh Ahmad, Rimon Uri, Raskin Daniel, Khaitovich Boris, Halak Moshe
Department of Vascular Surgery, The Chaim Sheba Medical Center, Tel Hashomer, The Sackler School of Medicine, Tel Aviv, Israel.
Department of Vascular Surgery, The Chaim Sheba Medical Center, Tel Hashomer, The Sackler School of Medicine, Tel Aviv, Israel.
J Vasc Surg. 2020 Sep;72(3):866-872. doi: 10.1016/j.jvs.2019.10.068. Epub 2020 Feb 17.
The use of fenestrated and branched endografts for the treatment of complex aortic aneurysms is increasing. Despite the low morbidity and mortality associated with these repairs, reintervention rates in the midterm and long term remain a concern. The purpose of this study was to investigate our experience with reinterventions after fenestrated and branched endovascular aneurysm repair (F/BEVAR).
We performed a retrospective analysis of all patients treated with F/BEVAR at our institution during the years 2009 to 2019. Among them, we identified those who required reinterventions during the period of follow-up. Data collected included patients' demographics, type of treated aneurysm, indications for reintervention, and methods of repair.
During the study period, 47 patients underwent F/BEVAR. A total of 160 branches were placed. Of those, 12 patients (25%) underwent 15 secondary interventions for late-occurring complications. Among those requiring reinterventions, mean age was 70 years (range, 59-80 years), and 10 (83%) were male. The majority of those requiring reinterventions were treated for thoracoabdominal aortic aneurysms. Mean time to reintervention was 14 months (range, 2-32 months). Indications for reinterventions included separation of side branches from fenestrations (nine), separation of side branches (three), type IA endoleak (one), type II endoleak (one), and limb occlusion (one). All endoleaks were detected on routine follow-up imaging. All reinterventions were performed using endovascular techniques. Mean follow-up after reinvention was 22 months (range, 1-53 months). During this period, no patient required open conversion. Follow-up imaging revealed successful obliteration of the endoleak, and none experienced continued growth of the sac.
Reinterventions after F/BEVAR are not uncommon. The majority of reinterventions are performed for endoleaks that are due to failure at the level of the fenestrations or component separation. These endoleaks can be treated successfully with endovascular methods and do not require open conversion. Because of the possibility of development of late endoleaks, continual monitoring of these patients is required after the primary procedure.
带窗孔和分支型血管内移植物用于治疗复杂性主动脉瘤的情况日益增多。尽管这些修复手术的发病率和死亡率较低，但中期和长期的再次干预率仍是一个令人担忧的问题。本研究的目的是调查我们在带窗孔和分支型血管腔内动脉瘤修复术（F/BEVAR）后进行再次干预的经验。
我们对2009年至2019年期间在本机构接受F/BEVAR治疗的所有患者进行了回顾性分析。其中，我们确定了那些在随访期间需要再次干预的患者。收集的数据包括患者的人口统计学资料、治疗的动脉瘤类型、再次干预的指征以及修复方法。
在研究期间，47例患者接受了F/BEVAR。共植入了160个分支。其中，12例患者（25%）因晚期并发症接受了15次二次干预。在需要再次干预的患者中，平均年龄为70岁（范围59 - 80岁），10例（83%）为男性。大多数需要再次干预的患者是因胸腹主动脉瘤接受治疗。再次干预的平均时间为14个月（范围2 - 32个月）。再次干预的指征包括侧支与窗孔分离（9例）、侧支分离（3例）、ⅠA型内漏（1例）、Ⅱ型内漏（1例）和肢体闭塞（1例）。所有内漏均在常规随访影像学检查中发现。所有再次干预均采用血管内技术进行。再次干预后的平均随访时间为22个月（范围1 - 53个月）。在此期间，没有患者需要转为开放手术。随访影像学检查显示内漏成功闭塞，且无一例患者瘤腔持续增大。
F/BEVAR术后再次干预并不少见。大多数再次干预是针对因窗孔水平失败或组件分离导致的内漏进行的。这些内漏可以通过血管内方法成功治疗，且不需要转为开放手术。由于可能出现晚期内漏，因此在初次手术后需要对这些患者进行持续监测。
