Department of Vascular Surgery, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv, Israel.
Division of Interventional Radiology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Vascular. 2021 Oct;29(5):644-651. doi: 10.1177/1708538120977279. Epub 2020 Dec 8.
To report our early experience using endografts with inner branches for the treatment of complex abdominal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs).
A retrospective analysis of all patients treated in our institution for complex abdominal aortic aneurysms and TAAAs with custom-made stent grafts consisting of one or more inner branches. Data collected included patients demographics, aortic aneurysm morphology, stent grafts features, perioperative morbidity and mortality and short-term reintervention and mortality rates.
Twenty-seven patients (18 males, mean age 70 ± 7.1) were included. Indications for surgery included TAAAs (12, 41%) juxtarenal abdominal aortic aneurysms (10, 37%), type 1A endoleaks (4, 15%) and paraanastamotic aneurysms (1, 4%). A total of 90 inner branches were used. Twenty-one (78%) of the stent grafts consisted only of inner branches and six (22%) had a combination of inner branches with either fenestrations or outer branches. Technical success was achieved in 26/27 (96%) of the patients. There was one perioperative mortality. Six patients suffered from major perioperative adverse events. Mean follow-up was seven months (range 1-23). During the follow-up period, four patients (15%) required reinterventions. Branch-related reinterventions were performed in two (7%) patients. No occlusions of inner branches occurred during the follow-up.
Inner branches in branched endovascular aneurysm repairs offer a feasible option for the treatment of complex abdominal aortic aneurysms and TAAAs. The procedures can be completed with high technical success and with acceptable short-term branch-related reintervention rates. Further follow-up is required to determine the long-term durability of this technology.
报告我们使用带分支内支架治疗复杂腹主动脉瘤和胸腹主动脉瘤（TAAA）的早期经验。
回顾性分析我院采用定制支架移植物治疗复杂腹主动脉瘤和 TAAA 的所有患者的临床资料，这些支架移植物由一个或多个分支内支架组成。收集的数据包括患者的人口统计学、主动脉瘤形态、支架移植物特征、围手术期发病率和死亡率以及短期再干预和死亡率。
共纳入 27 例患者（男性 18 例，平均年龄 70±7.1 岁）。手术指征包括 TAAA（12 例，41%）、肾下型腹主动脉瘤（10 例，37%）、1A 型内漏（4 例，15%）和吻合口旁动脉瘤（1 例，4%）。共使用了 90 个分支内支架。21 个（78%）支架移植物仅由分支内支架组成，6 个（22%）支架移植物既有分支内支架又有开窗或外支架。26/27 例（96%）患者获得了技术成功。有 1 例围手术期死亡。6 例患者发生严重围手术期不良事件。平均随访时间为 7 个月（1-23 个月）。随访期间，4 例患者（15%）需要再次干预。2 例（7%）患者进行了分支相关的再干预。在随访期间，没有分支内支架闭塞发生。
分支腔内动脉瘤修复术的分支内支架为治疗复杂腹主动脉瘤和 TAAA 提供了一种可行的选择。该手术可以达到很高的技术成功率，且分支相关再干预的短期发生率可接受。需要进一步随访以确定该技术的长期耐久性。
