Piazza Michele, Squizzato Francesco, Saviane Gianna, Grego Franco, Antonello Michele
Vascular and Endovascular Surgery Division, Padua University, Padua, Italy.
Vascular and Endovascular Surgery Division, Padua University, Padua, Italy.
Ann Vasc Surg. 2020 Aug;67:148-157. doi: 10.1016/j.avsg.2020.02.017. Epub 2020 Mar 20.
The purpose of the study is to perform a postimplantation geometrical analysis and to evaluate early and mid-term outcomes of new-generation balloon-expandable covered stents, used in the kissing conformation to treat obstructive lesions involving the aortic bifurcation.
A single-center retrospective review of all patients who underwent endovascular reconstruction of the aortoiliac bifurcation for obstructive disease, with the use of Viabahn balloon expandable stents (VBX; W. L. Gore & Associates, Flagstaff, AZ) deployed in the kissing conformation, from March 2018 to June 2019 was carried out. Two same-size kissing VBXs were simultaneously deployed from the distal aorta (1.5-2 cm above the aortic bifurcation) to the common iliac arteries; a kissing post-ballooning using compliant balloons was routinely performed to flare the proximal part of the VBX, to adapt to the aortic diameter and morphology. A postoperative computed tomography (CT) angiogram was obtained for all patients for the geometrical assessment. "Precision" of deployment was measured as protrusion mismatch, intended as the longitudinal distance between the stents' proximal ends. "Conformability" was measured as radial mismatch (area and volume of the "dead space" between the stented lumen and the aortic wall) and D-ratio (ratio of the major and minor axes in the axial view). Symmetry was measured as the ratio between the minor diameter of the 2 kissing stents at the same level.
Twenty-eight patients (56 limbs) underwent endovascular treatment with kissing VBXs for Trans-Atlantic Inter-Society Consensus II C (n = 10, 36%) or D (n = 18, 64%) lesions involving the aortic bifurcation. Two 8-mm diameter ("8L") VBX stents were used in most cases (n = 32, 57%). At the postoperative CT, the mean protrusion mismatch was 0.8 ± 1.7 mm and was <5 mm in all cases. The mean radial mismatch area was 20.4 ± 10.6 mm, and the mean radial mismatch volume was 2442 ± 182 mm. The mean D-ratio was 1.4 ± 0.2. Early procedural and postprocedural complication rates were 4% and 0%, respectively. After 9.7 ± 4.2 months of follow-up, no cases of limb occlusion or restenosis occurred.
The use of kissing VBX stents may represent a valid option for the treatment of obstructive lesions involving the aortic bifurcation, with excellent early and mid-term outcomes and achievement of optimal stents geometry.
本研究的目的是进行植入后几何分析，并评估新一代球囊扩张式覆膜支架以吻合法用于治疗累及主动脉分叉的阻塞性病变的早期和中期疗效。
对2018年3月至2019年6月期间所有使用Viabahn球囊扩张式支架（VBX；美国戈尔公司，弗拉格斯塔夫，亚利桑那州）以吻合法进行腹主动脉-髂动脉分叉处阻塞性疾病血管内重建的患者进行单中心回顾性研究。两个相同尺寸的吻合适配VBX从远端主动脉（主动脉分叉上方1.5 - 2厘米处）同时植入至双侧髂总动脉；常规使用顺应性球囊进行吻合适配后球囊扩张，以使VBX近端扩张，以适应主动脉直径和形态。所有患者术后均行计算机断层扫描（CT）血管造影以进行几何评估。“植入精度”通过突出错配来衡量，即支架近端之间的纵向距离。“贴合度”通过径向错配（支架管腔与主动脉壁之间“死腔”的面积和体积）和D值（轴向视图中长轴与短轴的比值）来衡量。对称性通过同一水平处两个吻合适配支架的短轴比值来衡量。
28例患者（56条肢体）接受了吻合适配VBX治疗累及主动脉分叉的跨大西洋跨学会共识（TASC）II C型（n = 10，36%）或D型（n = 18，64%）病变。大多数病例（n = 32，57%）使用两个直径8毫米（“8L”）的VBX支架。术后CT显示，平均突出错配为0.8 ± 1.7毫米，所有病例均<5毫米。平均径向错配面积为20.4 ± 10.6平方毫米，平均径向错配体积为2442 ± 182立方毫米。平均D值为1.4 ± 0.2。早期手术及术后并发症发生率分别为4%和0%。经过9.7 ± 4.2个月的随访，未发生肢体闭塞或再狭窄病例。
使用吻合适配VBX支架可能是治疗累及主动脉分叉的阻塞性病变的有效选择，具有优异的早期和中期疗效，并能实现最佳的支架几何形态。
