Division of Vascular Surgery, Department of Surgery, Stanford University Hospital, Stanford, CA.
Division of Vascular Surgery, Department of Surgery, Stanford University Hospital, Stanford, CA.
Ann Vasc Surg. 2021 Apr;72:106-113. doi: 10.1016/j.avsg.2020.10.020. Epub 2020 Nov 27.
To report renal outcomes including long-term patency, secondary interventions, and related renal function after fenestrated endovascular aortic repair (fEVAR).
Single-center retrospective review of patients undergoing fEVAR between 2012 and 2018 using the Cook ZFEN device. Renal stent complications, defined as any stenosis, occlusion, kink, renal stent-related endoleak, and reinterventions were tabulated. Estimated glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease formula.
During the study period, 114 patients underwent elective fEVAR. Of 329 total target vessels, 193 renal arteries were stented (133 Atrium iCAST, 60 Gore VBX). Technical success was achieved in 97.4%, and the mean follow-up was 23.3 months. Seventeen renal complications occurred in 14 patients (12.3%), including 4 occlusions, 9 stenosis, 3 dislocations, and 1 type III endoleak. All stent complications underwent endovascular reintervention with a median hospital stay of 1 day (0-10) and a technical success of 94.2%. One patient suffered renal hemorrhage that warranted embolization. Patients with occlusion were treated the day of diagnosis, and mean time from diagnosis to intervention for stenosis was 21.5 days. Estimated primary patency was 92.1 % and 81.5% at 24 and 48 months, respectively. On multivariate analysis, larger native renal artery diameter was the only independent protective factor against patency loss (HR 0.23 (0.09-0.59)). Secondary patency at latest follow-up was 99.4%. Mean eGFR was not significantly different at latest follow-up between patients with renal complications versus those without (43.75 vs. 55.58 mL/min/1.73 m, P = 0.09). Comparing patients with and without renal stent complications, 81.4% and 72.7% of patients had stable or improved renal disease by chronic kidney disease staging compared with baseline (P = 0.51).
fEVAR is a durable option for the treatment of juxtarenal aortic aneurysms and is associated with excellent secondary patency. Renal stent complications have no significant impact on renal function, but smaller native renal arteries are at higher risk of stent-graft complications.
报告采用开窗血管内主动脉修复术（fEVAR）治疗后，包括长期通畅、二次干预和相关肾功能的肾脏结局。
对 2012 年至 2018 年期间采用库克 ZFEN 装置进行 fEVAR 的患者进行单中心回顾性研究。将肾支架并发症（任何狭窄、闭塞、扭曲、肾支架相关内漏和再干预）列成表格。采用肾脏病饮食改良公式（Modification of Diet in Renal Disease formula）估算肾小球滤过率（eGFR）。
在研究期间，114 例患者接受了择期 fEVAR。329 个目标血管中有 193 个肾动脉进行了支架置入（133 个 Atrium iCAST，60 个 Gore VBX）。技术成功率为 97.4%，平均随访时间为 23.3 个月。14 例患者发生 17 例肾并发症（12.3%），包括 4 例闭塞、9 例狭窄、3 例脱位和 1 例 III 型内漏。所有支架并发症均经血管内再干预治疗，中位住院时间为 1 天（0-10 天），技术成功率为 94.2%。1 例患者发生肾出血，需行栓塞治疗。闭塞患者在诊断当天接受治疗，狭窄患者从诊断到介入治疗的平均时间为 21.5 天。估计 24 个月和 48 个月时的主要通畅率分别为 92.1%和 81.5%。多因素分析显示，较大的原生肾动脉直径是通畅率丧失的唯一独立保护因素（HR 0.23（0.09-0.59））。最新随访时的继发性通畅率为 99.4%。最新随访时，有肾并发症的患者与无肾并发症的患者的 eGFR 无显著差异（43.75 与 55.58 mL/min/1.73 m，P=0.09）。比较有和无肾支架并发症的患者，慢性肾脏病分期与基线相比，81.4%和 72.7%的患者肾脏疾病稳定或改善（P=0.51）。
fEVAR 是治疗肾下型腹主动脉瘤的一种持久选择，具有极好的继发性通畅率。肾支架并发症对肾功能没有显著影响，但较小的原生肾动脉发生支架移植物并发症的风险更高。
