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形状记忆聚合物外周血管栓塞栓子的临床经验:病例系列

Clinical experience with a shape memory polymer peripheral vascular embolisation plug: a case series.

作者信息

Morgan Robert A, Loftus Ian, Ratnam Lakshmi, Das Raj, Mailli Leto, Hamady Mohamad S, Lobotesis Kyriakos

机构信息

Department of Radiology, St. George's University Hospitals NHS Foundation Trust, London, GB, UK.

Vascular Institute, St. George's Healthcare NHS Trust, London, GB, UK.

出版信息

CVIR Endovasc. 2021 Mar 9;4(1):29. doi: 10.1186/s42155-021-00214-w.

Abstract

BACKGROUND

Shape memory polymers are materials that are manufactured in a certain shape, can be stored in a temporary deformed shape, and then return to - or remember - their original shape upon exposure to external stimuli such as temperature and moisture. This property lends itself to application in endovascular medical devices. Peripheral vasculature embolisation devices incorporating this novel technology have become commercially available and this case series, where the data were collected as part of a post market registry, outlines initial clinical experience with these novel devices.

RESULTS

Eight cases are described in this series. The disease state/conditions for which embolisation was indicated were right common iliac artery aneurysms (n = 3), a type II endoleak into the thoracic aorta following thoracic endovascular aneurysm repair (n = 1), a left inferior gluteal artery aneurysm (n = 1), left internal iliac artery aneurysms (n = 2), and a case of splenomegaly, where splenectomy was planned after the embolisation procedure (n = 1). Target arteries were 5-10 mm in diameter. In each case, at least one IMPEDE Embolization Plug (IMP-Device) of an appropriate diameter was used. All procedures were technically successful and target vessel thrombosis was achieved in all cases. Follow-up imaging available during the 45-90-day data collection timeframe showed sustained vessel occlusion. This case series includes examples of situations commonly encountered when embolising the peripheral vasculature, namely, the use of one or multiple devices in a single vessel and in combination with the use of other embolic devices (e.g., microcoils, gelatin sponge, and PVA particles) in the same case. There were no adverse events related to the specific use of the device.

CONCLUSIONS

This small series illustrates the safety and efficacy of this novel sponge-based embolic device for the embolisation of small and medium sized arteries and further experience will demonstrate the utility of the shape memory polymer devices.

摘要

背景

形状记忆聚合物是一种制成特定形状的材料,可存储于临时变形状态,然后在受到温度和湿度等外部刺激时恢复或记住其原始形状。这一特性使其适用于血管内医疗设备。采用这项新技术的外周血管栓塞装置已上市,本病例系列作为上市后注册的一部分收集数据,概述了这些新型装置的初步临床经验。

结果

本系列描述了8例病例。栓塞治疗所针对的疾病状态/情况包括右髂总动脉瘤(n = 3)、胸主动脉瘤腔内修复术后II型内漏至胸主动脉(n = 1)、左臀下动脉瘤(n = 1)、左髂内动脉瘤(n = 2),以及一例脾肿大,计划在栓塞术后行脾切除术(n = 1)。靶动脉直径为5 - 10毫米。在每例病例中,均使用了至少一个直径合适的IMPEDE栓塞栓子(IMP装置)。所有手术在技术上均获成功,所有病例均实现了靶血管血栓形成。在45 - 90天的数据收集时间范围内获得的随访影像显示血管持续闭塞。本病例系列包括外周血管栓塞时常见情况的实例,即在单个血管中使用一个或多个装置,并在同一病例中与其他栓塞装置(如微线圈、明胶海绵和聚乙烯醇颗粒)联合使用。未发生与该装置特定使用相关的不良事件。

结论

这个小系列病例说明了这种新型海绵基栓塞装置用于中小动脉栓塞的安全性和有效性,更多经验将证明形状记忆聚合物装置的实用性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2518/7943681/f8d94e3123e9/42155_2021_214_Fig1_HTML.jpg

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