Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, Madrid, Spain.
Department of Vascular Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
J Endovasc Ther. 2020 Apr;27(2):240-247. doi: 10.1177/1526602820907564.
To analyze aortic wall penetration of Heli-FX EndoAnchors after use in seal zones in the aortic arch or descending thoracic aorta during thoracic endovascular aortic repair (TEVAR). From May 2014 to May 2019, 25 patients (mean age 70.5±10 years; 16 women) were treated with TEVAR and adjunctive use of the Heli-FX device in 3 academic vascular surgery departments. Computed tomography scans were retrospectively reviewed to determine the location [arch or descending thoracic aorta (DTA)] of the EndoAnchors and the adequacy of aortic wall penetration, defined as adequate (≥2 mm), partial (<2 mm), or inadequate wall penetration (including loss). Endoleaks, reinterventions, and mortality were assessed. A total of 161 EndoAnchors were deployed (median 7 per patient, range 4-9). Twenty-two EndoAnchors were place in the arch (zones 0-2) and 139 in the DTA (zones 3-5). A larger proportion of arch deployments (27%) had suboptimal penetration compared with the DTA (6.5%; p<0.005), resulting in a 91% adequate wall penetration rate for the series overall. Three EndoAnchors were lost (and only 1 retrieved) in 3 different patients, with no additional morbidity; thus, an overall deployment success rate of 88% was achieved. At a mean follow-up of 16.6±14 months, 4 patients required 5 (successful) reinterventions, including one for a type Ia endoleak treated with chimney TEVAR. One patient died 10 months after treatment due to endograft infection, without an opportunity for surgical correction. EndoAnchors have a higher risk of maldeployment in the arch, though this may be attributable to the small learning curve experience in this location. The best aortic wall penetration for this series was in the DTA, where EndoAnchors proved useful for distal endograft fixation during TEVAR.
分析在胸主动脉腔内修复术（TEVAR）中使用 Helix-FX 腔内锚钉（EndoAnchors）在主动脉弓或降主动脉密封区的主动脉壁穿透情况。 2014 年 5 月至 2019 年 5 月，3 个学术血管外科部门对 25 例（平均年龄 70.5±10 岁；16 例女性）患者进行了 TEVAR 治疗和 Helix-FX 器械辅助治疗。回顾性分析 CT 扫描，以确定 EndoAnchors 的位置（弓或降主动脉（DTA））和主动脉壁穿透的充分性，定义为充分（≥2mm）、部分（<2mm）或不足（包括丢失）。评估了内漏、再次干预和死亡率。共放置 161 个 EndoAnchors（中位数每个患者 7 个，范围 4-9 个）。22 个 EndoAnchors 放置在弓部（0-2 区），139 个放置在 DTA（3-5 区）。与 DTA（6.5%）相比，弓部放置的 EndoAnchors （27%）穿透不足的比例更大，因此该系列的总体主动脉壁穿透率为 91%。3 例患者的 3 个 EndoAnchors 丢失（仅 1 个可回收），无额外并发症；因此，总体植入成功率达到 88%。在平均 16.6±14 个月的随访中，4 例患者需要进行 5 次（成功）再次干预，包括 1 例因 I 型内漏采用烟囱 TEVAR 治疗。1 例患者在治疗后 10 个月因移植物感染死亡，无手术矫正机会。 在弓部，EndoAnchors 的植入失败风险更高，尽管这可能归因于该部位的学习曲线经验不足。该系列中最佳的主动脉壁穿透部位是 DTA，EndoAnchors 在 TEVAR 中用于远端移植物固定非常有用。
