Auckland Hospital, Auckland, New Zealand.
Cardiovasc Intervent Radiol. 2020 Dec;43(12):1788-1797. doi: 10.1007/s00270-020-02563-w. Epub 2020 Jun 21.
This paper reviews the development of endovascular aneurysm repair (EVAR) of infra-renal aortic and iliac artery aneurysms and considers the current status and best treatment options. The vast majority of devices are bifurcated and exclude the aneurysm utilizing the same techniques for fixation and seal. The modern EVAR procedure is usually performed in a hybrid operating theatre, utilizing image fusion and other radiation-reducing techniques and using optimized procedural techniques, including percutaneous access. The best outcomes are achieved in patients whose anatomy is within device "instructions for use", but these are most commonly breached due to "hostile" neck anatomy. Endovascular options for these cases include the use of fenestrated endografts, chimney grafts and endoanchors. Concomitant iliac artery aneurysms often occur with abdominal aortic aneurysms, and endovascular options include limb extensions with internal iliac embolization as well as iliac branch devices. The durability of EVAR has recently been called into question by long-term results from early EVAR randomized trial. Findings such as infra-renal neck dilatation and aneurysm sac expansion are relatively common and associated with adverse outcomes. This durability concern mandates regular and long-term imaging and clinical surveillance. It also indicates that EVAR technology is not fully evolved with a need for further development to improve patient applicability and long-term durability.
本文回顾了腹主动脉瘤和髂动脉瘤的血管内治疗（EVAR）的发展，并考虑了目前的状况和最佳治疗选择。绝大多数装置都是分叉式的，通过相同的固定和密封技术来排除动脉瘤。现代 EVAR 手术通常在杂交手术室中进行，利用图像融合和其他降低辐射的技术，并采用优化的手术技术，包括经皮入路。在解剖结构符合设备“使用说明”的患者中，可获得最佳效果，但由于“敌对”的颈部解剖结构，这些最常被突破。对于这些病例，血管内治疗的选择包括使用开窗支架、烟囱支架和内锚定支架。与腹主动脉瘤同时发生的髂动脉瘤，血管内治疗的选择包括内髂动脉栓塞的分支延长和髂支装置。早期 EVAR 随机试验的长期结果对 EVAR 的耐久性提出了质疑。如肾下颈部扩张和动脉瘤囊扩张等发现较为常见，并与不良结局相关。这种耐久性问题需要定期和长期的影像学和临床监测。这也表明，EVAR 技术尚未完全发展成熟，需要进一步开发以提高患者适用性和长期耐久性。
