Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Multimodality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
J Endovasc Ther. 2021 Oct;28(5):700-706. doi: 10.1177/15266028211016423. Epub 2021 May 19.
Fenestrated endovascular aneurysm repair (FEVAR) is a well-established endovascular treatment option for pararenal abdominal aortic aneurysms in which balloon-expandable covered stents (BECS) are used to bridge the fenestration to the target vessels. This study presents midterm clinical outcomes and patency rates of the Advanta V12 BECS used as a bridging stent.
All patients treated with FEVAR with at least 1 Advanta V12 BECS were included from 2 large-volume vascular centers between January 2012 and December 2015. Primary endpoints were freedom from all-cause reintervention, and freedom from BECS-associated complications and reintervention. BECS-associated complications included significant stenosis, occlusion, type 3 endoleak, or stent fracture. Secondary endpoints included all-cause mortality in-hospital and during follow-up.
This retrospective study included 194 FEVAR patients with a mean age of 72.2±8.0 years. A total of 457 visceral arteries were stented with an Advanta V12 BECS. Median (interquartile range) follow-up time was 24.6 (1.6, 49.9) months. The FEVAR procedure was technically successful in 93% of the patients. Five patients (3%) died in-hospital. Patient survival was 77% (95% CI 69% to 84%) at 3 years. Freedom from all-cause reintervention was 70% (95% CI 61% to 78%) at 3 years, and 33% of all-cause reinterventions were BECS associated. Complications were seen in 24 of 457 Advanta V12 BECSs: type 3 endoleak in 8 BECSs, significant stenosis in 4 BECSs, occlusion in 6 BECSs, and stent fractures in 3 BECSs. A combination of complications occurred in 3 BECSs: type 3 endoleak and stenosis, stent fracture and stenosis, and stent fracture and occlusion. The freedom from BECS-associated complications for Advanta V12 BECSs was 98% (95% CI 96% to 99%) at 1 year and 92% (95% CI 88% to 95%) at 3 years. The freedom from BECS-associated reinterventions was 98% (95% CI 95% to 100%) at 1 year and 94% (95% CI 91% to 97%) at 3 years.
The Advanta V12 BECS used as bridging stent in FEVAR showed low complication and reintervention rates at 3 years. A substantial number of FEVAR patients required a reintervention, but most were not BECS related.
在腹主动脉瘤中，采用球扩覆膜支架（BECS）进行腔内治疗是一种成熟的方法，用于桥接 fenestration 与目标血管。本研究旨在报道 Advanta V12 BECS 作为桥接支架的中期临床结果和通畅率。
本研究回顾性分析了 2012 年 1 月至 2015 年 12 月期间在 2 个大型血管中心接受 FEVAR 治疗且至少使用 1 枚 Advanta V12 BECS 的患者。主要终点为全因再干预、BECS 相关并发症和再干预的无失败率。BECS 相关并发症包括严重狭窄、闭塞、III 型内漏或支架断裂。次要终点包括住院和随访期间的全因死亡率。
本研究共纳入 194 例接受 FEVAR 治疗的患者，平均年龄为 72.2±8.0 岁。共对 457 支内脏动脉进行了 Advanta V12 BECS 支架置入。中位（四分位距）随访时间为 24.6（1.6，49.9）个月。93%的患者 FEVAR 手术技术成功。5 例（3%）患者住院期间死亡。3 年时患者生存率为 77%（95%CI 69%至 84%）。3 年时全因再干预无失败率为 70%（95%CI 61%至 78%），其中 33%的再干预与 BECS 相关。在 457 枚 Advanta V12 BECS 中，共发生 24 例并发症：8 例 BECS 发生 III 型内漏，4 例发生严重狭窄，6 例发生闭塞，3 例发生支架断裂。3 例 BECS 发生了并发症的组合：III 型内漏和狭窄、支架断裂和狭窄、支架断裂和闭塞。Advanta V12 BECS 发生 BECS 相关并发症的无失败率为 1 年时 98%（95%CI 96%至 99%），3 年时为 92%（95%CI 88%至 95%）。1 年时，BECS 相关再干预的无失败率为 98%（95%CI 95%至 100%），3 年时为 94%（95%CI 91%至 97%）。
在 FEVAR 中，采用 Advanta V12 BECS 作为桥接支架，3 年时并发症和再干预率较低。相当一部分 FEVAR 患者需要再次干预，但大多数与 BECS 无关。
