血管内动脉瘤封堵联合烟囱型移植物后的移位
Migration After Endovasclar Aneurysm Sealing in Conjunction With Chimney Grafts.
作者信息
Zoethout Aleksandra C, Sheriff Arshad, Zeebregts Clark J, Reijnen Michel M P J, Hill Andrew, Holden Andrew
机构信息
Department of Interventional Radiology and Vascular Surgery, Auckland City Hospital, Auckland, New Zealand.
Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, the Netherlands.
出版信息
J Endovasc Ther. 2021 Feb;28(1):165-172. doi: 10.1177/1526602820957279. Epub 2020 Sep 10.
PURPOSE
To assess the incidence of migration after endovascular aneurysm sealing (EVAS) in conjunction with chimney grafts (chEVAS) for repair of abdominal aortic aneurysms (AAAs).
MATERIALS AND METHODS
A retrospective, observational cohort study was conducted of 31 patients (mean age 75.7 years; 27 men) treated for juxtarenal AAA between April 2013 and December 2018 at single centers in New Zealand and the Netherlands. The majority of patients received >1 chimney graft (13 single, 13 double, and 5 triple) during chEVAS. Six patients had only the first postoperative scan, so the migration analysis was based on 25 patients.
RESULTS
Median seal length assessed on the first postoperative computed tomography scan was 36.5 mm. The assisted technical success rate was 93.5% with 2 technical failures. Median time to final imaging follow-up was 17 months in 25 patients. At the latest follow-up, there were no cases of caudal migration >10 mm. Freedom from caudal movement of 5 to 9 mm was estimated as 86.1% at 1 year and 73.9% at 2 years; freedom from clinically relevant migration (movement requiring reintervention) was 100% at both time intervals. However, at 3 years there were 2 cases of caudal movement of 5 to 9 mm and a type Ia endoleak warranting reintervention. No correlation between migration and aneurysm growth (p=0.851), endoleak (p=0.562), or the number of chimney grafts (p=0.728) was found. During follow-up, 2 patients (7%) had aneurysm rupture and 10 (33%) had reinterventions. Eight patients (27%) died; 2 were aneurysm-related (7%) and due to the consequences of a reintervention.
CONCLUSION
In the 2 years following chEVAS, there was no caudal migration >10 mm, but nearly a quarter of patients had caudal movement of 5 to 9 mm. A trend was observed toward ongoing migration that required intervention at 3-year follow-up. chEVAS is technically challenging and should be considered only for patients with no viable alternative treatment option.
目的
评估血管腔内动脉瘤封闭术（EVAS）联合烟囱型移植物（chEVAS）修复腹主动脉瘤（AAA）后移植物移位的发生率。
材料与方法
对2013年4月至2018年12月期间在新西兰和荷兰的单一中心接受近肾型AAA治疗的31例患者（平均年龄75.7岁；27例男性）进行了一项回顾性观察队列研究。大多数患者在chEVAS期间接受了>1个烟囱型移植物（13个单烟囱、13个双烟囱和5个三烟囱）。6例患者仅进行了术后首次扫描，因此移植物移位分析基于25例患者。
结果
术后首次计算机断层扫描评估的中位封堵长度为36.5mm。辅助技术成功率为93.5%，有2例技术失败。25例患者最终影像学随访的中位时间为17个月。在最近一次随访时，没有尾端移位>10mm的病例。1年时尾端移位5至9mm的无移位率估计为86.1%，2年时为73.9%；两个时间点临床相关移位（需要再次干预的移位）的无移位率均为100%。然而，在3年时，有2例尾端移位5至9mm的病例以及1例需要再次干预的Ia型内漏。未发现移位与动脉瘤生长（p=0.851）、内漏（p=0.562）或烟囱型移植物数量（p=0.728）之间存在相关性。随访期间，2例患者（7%）发生动脉瘤破裂，10例患者（33%）接受了再次干预。8例患者（27%）死亡；2例与动脉瘤相关（7%），死因是再次干预的后果。
结论
在chEVAS后的2年里，没有尾端移位>10mm的情况，但近四分之一的患者有5至9mm的尾端移位。在3年随访时观察到一种持续移位的趋势，这种移位需要进行干预。chEVAS在技术上具有挑战性，仅应考虑用于没有可行替代治疗方案的患者。
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