Grandhomme Jonathan, Chakfe Nabil, Chaudhuri Arindam, Wyss Thomas R, Chiesa Roberto, Chakfe Julien, Dion Delphine, Heim Frédéric, Lejay Anne
Groupe Européen de Recherche sur les Prothèses appliquées à la Chirurgie Vasculaire, Strasbourg, France.
Department of Vascular Surgery and Renal Transplantation, Nouvel Hôpital Civil, Strasbourg, France.
EJVES Vasc Forum. 2020 Aug 29;49:4-10. doi: 10.1016/j.ejvsvf.2020.08.002. eCollection 2020.
The adjunctive use of Heli-FX EndoAnchors (EAs) in endovascular aneurysm repair has been proposed for the treatment or prevention of type Ia endoleaks. The aim of this study was to evaluate the impact of the penetration of EAs on endograft textile structure from two aortic endografts that had been explanted for persistent type Ia endoleak despite the implantation of EAs.
An Aorfix aortic endograft was implanted in an 85 year old man. Six months later, six EAs were implanted for Ia endoleak. The endograft was explanted as an emergency seven months later for aneurysm rupture. An Endurant II aortic endograft was implanted in an 80 year old man. Seven EAs were implanted 24 months later for type Ia endoleak. A proximal cuff extension with bilateral renal and superior mesenteric artery chimneys was performed 18 months later to treat a persistent type Ia endoleak. Endograft explantation was performed six months later owing to persistent type Ia endoleak and aneurysm sac enlargement. Explant analysis in both cases was performed at GEPROVAS.
Systematic analysis of both explants, including the 13 EAs, revealed the following lesions: (1) alteration of textile structure directly linked to several penetrations of the fabric with the same EA and tears of the textile fibres in two cases; (2) tears of the binding threads as the EA had passed through them in five cases; and (3) interactions between EA and endograft stents in four cases.
The site of EA penetration into the endograft might contribute to endograft fabric damage and to a loss of stability of the endograft at the level of the aortic neck.
有人提出在血管内动脉瘤修复术中辅助使用Heli-FX内固定锚（EA）来治疗或预防Ia型内漏。本研究的目的是评估EA穿透对两种主动脉腔内移植物的腔内移植物织物结构的影响，这两种移植物因尽管植入了EA但仍存在持续性Ia型内漏而被取出。
将一个Aorfix主动脉腔内移植物植入一名85岁男性体内。六个月后，为治疗Ia型内漏植入了6个EA。七个月后，因动脉瘤破裂紧急取出了腔内移植物。将一个Endurant II主动脉腔内移植物植入一名80岁男性体内。24个月后，为治疗Ia型内漏植入了7个EA。18个月后，进行了近端袖带延伸并带有双侧肾动脉和肠系膜上动脉烟囱以治疗持续性Ia型内漏。六个月后，由于持续性Ia型内漏和动脉瘤囊增大，进行了腔内移植物取出。两例病例的取出物分析均在GEPROVAS进行。
对包括13个EA在内的两个取出物进行系统分析，发现了以下病变：（1）织物结构改变，直接与同一EA多次穿透织物以及两例中的纺织纤维撕裂有关；（2）五例中，当EA穿过时，捆绑线撕裂；（3）四例中，EA与腔内移植物支架之间存在相互作用。
EA穿透进入腔内移植物的部位可能导致腔内移植物织物损伤以及主动脉颈部水平的腔内移植物稳定性丧失。
