Han Sukgu M, Tenorio Emanuel R, Mirza Aleem K, Zhang Louis, Weiss Salome, Oderich Gustavo S
Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA.
Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
Ann Vasc Surg. 2020 Aug;67:14-25. doi: 10.1016/j.avsg.2020.02.022. Epub 2020 Mar 20.
The aim of this study is to describe a modification technique using the low-profile Cook Zenith Alpha™ thoracic stent graft, and addition of a preloaded wire system, for urgent repair of pararenal (PRA) and thoracoabdominal (TAAA) aortic aneurysms.
We analyzed 20 consecutive patients who underwent urgent physician modified endograft repair (PMEG) of PRA and TAAA at 2 institutions. The low-profile Cook Zenith Alpha Thoracic stent graft was modified in accordance with each specific patient anatomic characteristics. End points were technical success, 30-day mortality, and major adverse events (MAEs).
Technical success was achieved in all patients (100%). A total of 76 renal-mesenteric arteries were incorporated by fenestrations (70%) or directional branches (30%) with an average of 3.7 ± 0.6 vessels per patient. There were 6 different types of stent configuration. The most common design consisted of 4 fenestrations (9 patients, 45%). The average of modification time was 110 ± 27 minutes. Total procedure time (including the time for open component) was 242 ± 75 minutes. There was no death within the first 30 days or hospital stay. MAEs occurred in 10 patients (50%). The most common MAEs were acute kidney injury (by Risk, Injury, and Failure; and Loss; and End-stage kidney disease criteria) in 6 patients (30%), estimated blood loss >1 L, respiratory failure requiring reintubation in 2 patients (10%) each, and paraplegia and ischemic colitis in 1 patient (5%) each. One patient (5%) required temporary, new-onset dialysis.
PMEG using low-profile Zenith Alpha thoracic stent graft was safe with no early mortality and acceptable early morbidity.
本研究的目的是描述一种使用低轮廓Cook Zenith Alpha™胸主动脉覆膜支架，并添加预加载导丝系统，用于急诊修复肾旁（PRA）和胸腹主动脉（TAAA）瘤的改良技术。
我们分析了在2家机构接受PRA和TAAA急诊医生改良腔内修复术（PMEG）的20例连续患者。低轮廓Cook Zenith Alpha胸主动脉覆膜支架根据每位患者的具体解剖特征进行改良。终点指标为技术成功率、30天死亡率和主要不良事件（MAE）。
所有患者均获得技术成功（100%）。共有76支肾肠系膜动脉通过开窗（70%）或定向分支（30%）进行重建，平均每位患者3.7±0.6支血管。共有6种不同类型的支架构型。最常见的设计包括4个开窗（9例患者，45%）。平均改良时间为110±27分钟。总手术时间（包括开放部分的时间）为242±75分钟。术后30天内或住院期间无死亡病例。10例患者（50%）发生MAE。最常见的MAE是6例患者（30%）发生急性肾损伤（根据风险、损伤、衰竭、丧失和终末期肾病标准），估计失血量>1L，2例患者（10%）分别发生需要再次插管的呼吸衰竭，1例患者（5%）分别发生截瘫和缺血性结肠炎。1例患者（5%）需要临时进行新发透析。
使用低轮廓Zenith Alpha胸主动脉覆膜支架进行PMEG是安全的，无早期死亡，早期发病率可接受。
