Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
J Vasc Surg. 2021 May;73(5):1504-1512. doi: 10.1016/j.jvs.2020.07.101. Epub 2020 Aug 28.
Target artery stenosis might affect the outcomes of fenestrated/branched endovascular aortic aneurysm repair (F-BEVAR). The aim of the present study was to assess the effects of preoperative stenosis of the celiac artery (CA) and superior mesenteric artery (SMA) on the target artery outcomes after F-BEVAR.
During a 4-year period, 287 consecutive patients, 204 men (71%) and 83 women (29%), had undergone F-BEVAR using fenestrated (83%), fenestrated-branched (4.5%), branched (3.5%), and off-the-shelf t-Branch (9%) devices (Cook Medical Inc, Bloomington, Ind). Preoperative SMA and CA significant stenosis was defined as a computed tomography angiography-based intraluminal diameter reduction >50%. The primary endpoints included primary patency, freedom from target vessel instability, and patient survival.
The median patient age was 71 years (interquartile range, 67-77 years). Suprarenal (36%), juxtarenal (25%), and thoracoabdominal (39%) aortic aneurysms were treated. The technical success rate was 99%. The 30-day survival was 97%. Among 981 stented vessels, 179 (18%) were CAs and 270 (27.5%) were SMAs. Significant preoperative CA stenosis was identified in 39 patients (22%) and SMA stenosis in 24 (9%). The median follow-up was 29.9 months. The primary patency rates at 12, 36, and 60 months were 98%, 92%, and 92% for the CA and 99%, 98%, and 98% for the SMA, respectively. Primary patency was significantly lower in the patients with previous significant CA stenosis than in those without stenosis (83%, 83%, and 76% vs 100%, 100%, and 97% at 12, 36, and 60 months, respectively; P < .01). Freedom from celiac branch instability was also significantly lower among patients with significant stenosis (84%, 84%, and 76% vs 100%, 93%, and 93% at 12, 36, and 60 months; P < .01). The presence of significant SMA stenosis did not affect either primary patency or freedom from target vessel instability. The survival rates at 12, 36, and 60 months were significantly lower for the patients with CA stenosis than for those without stenosis (67%, 61%, and 55% vs 90%, 84%, and 82%, respectively; P < .01). Similarly, lower survival rates were observed for patients with significant SMA stenosis (70%, 60%, and 60% vs 87%, 79%, and 78% at 12, 36, and 60 months, respectively; P = .04).
F-BEVAR was associated with overall primary patency rates >90% for the CA and SMA. Preoperative CA stenosis was associated with lower primary patency and freedom from target vessel instability. In contrast, neither SMA branch primary patency nor freedom from target vessel instability were affected by preoperative SMA stenosis. We found visceral artery stenosis was a marker of atherosclerosis burden associated with reduced mid- and long-term patient survival.
靶动脉狭窄可能会影响腔内分支主动脉瘤修复术（F-BEVAR）的结果。本研究旨在评估术前腹腔动脉（CA）和肠系膜上动脉（SMA）狭窄对 F-BEVAR 后靶动脉结局的影响。
在 4 年期间，287 例连续患者（204 名男性[71%]和 83 名女性[29%]）接受了 F-BEVAR 治疗，使用了 fenestrated（83%）、fenestrated-branched（4.5%）、branched（3.5%）和 off-the-shelf t-Branch（9%）设备（库克医疗公司，印第安纳州布鲁明顿）。术前 SMA 和 CA 显著狭窄定义为基于计算机断层血管造影的管腔内径减少>50%。主要终点包括主要通畅率、靶血管稳定性和患者生存率。
患者中位年龄为 71 岁（四分位间距，67-77 岁）。治疗了肾上（36%）、肾旁（25%）和胸腹主动脉瘤（39%）。技术成功率为 99%。30 天生存率为 97%。在 981 个支架血管中，179 个（18%）为 CA，270 个（27.5%）为 SMA。39 例（22%）患者存在明显的术前 CA 狭窄，24 例（9%）患者存在 SMA 狭窄。中位随访时间为 29.9 个月。CA 的 12、36 和 60 个月的主要通畅率分别为 98%、92%和 92%，SMA 分别为 99%、98%和 98%。与无狭窄的患者相比，先前有明显 CA 狭窄的患者的主要通畅率显著降低（分别为 12、36 和 60 个月时的 83%、83%和 76%与 100%、100%和 97%；P<0.01）。有明显狭窄的患者的腹腔分支不稳定的发生率也明显较低（分别为 12、36 和 60 个月时的 84%、84%和 76%与 100%、93%和 93%；P<0.01）。SMA 显著狭窄并不影响主要通畅率或靶血管稳定性。与无狭窄的患者相比，有 CA 狭窄的患者的生存率显著降低（分别为 12、36 和 60 个月时的 67%、61%和 55%与 90%、84%和 82%；P<0.01）。同样，SMA 狭窄患者的生存率也较低（分别为 12、36 和 60 个月时的 70%、60%和 60%与 87%、79%和 78%；P=0.04）。
F-BEVAR 与 CA 和 SMA 的总体主要通畅率>90%相关。术前 CA 狭窄与较低的主要通畅率和靶血管稳定性相关。相比之下，术前 SMA 分支的通畅率和靶血管稳定性不受 SMA 狭窄的影响。我们发现内脏动脉狭窄是与中、长期患者生存率降低相关的动脉粥样硬化负担的标志物。
