Department of Vascular Surgery, National-Guangdong Joint Engineering Laboratory for Diagnosis an Treatment of Vascular Diseases, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Anesthesia Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
J Endovasc Ther. 2023 Apr;30(2):163-175. doi: 10.1177/15266028221075236. Epub 2022 Feb 18.
To evaluate the effectiveness and safety of using off-the-shelf "Octopus" technique to treat ruptured or symptomatic thoracoabdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm (PRAAA).
All cases who underwent "Octopus" technique from May 2016 to May 2019 at our center were retrospectively analyzed. A total of 10 cases (8 males) were included. The mean age was 54.5±14.2 years (range: 31-80 years). Eight cases presented as aneurysm rupture or impending rupture accepted emergency repair. Technical success, defined by placement of all endografts as planned, was achieved in all cases. A total of 30 target visceral branches were successfully cannulated, 9 celiac arteries were covered intentionally. Intraoperative endoleak was observed in 6 patients, all of them were gutter leak. During hospital stay, there was no death, no side branch occlusion or spinal cord ischemia. Median follow-up was 30 months (range: 12-50 months). One patient died of lung cancer at 14-month follow-up. There was no secondary endoleak. The primary endoleak were found spontaneously resolved in 3 cases at 7 days, 3-month, and 1-year imaging. One persistent endoleak totally resolved after sealing of gutter spaces at 4-month follow-up. The other 2 persistent endoleak decreased during follow-up, which are still under observation. The branch patency rate was 90.3% (28/31). All the 3 occluded branches were renal arteries. Branch occlusion occurred in 2 cases at 1-month follow-up and 1 case at 2-year follow-up, but renal insufficiency was not observed in these cases. Obvious aneurysm sac shrinkage (≥5 mm) was observed in all cases. The aneurysm size shrunk from 7.6±1.9 to 5.5±1.4 cm. No spinal cord ischemia occurred during follow-up.
Treatment of ruptured TAAA and PRAAA with "Octopus" technique is feasible and safe for high surgical risk patients in the absence of fenestrated and branched devices. The long-term clinical outcomes needed to be investigated.
评估使用市售“八爪鱼”技术治疗破裂或有症状的胸腹主动脉瘤（TAAA）和肾周腹主动脉瘤（PRAAA）的有效性和安全性。
回顾性分析了 2016 年 5 月至 2019 年 5 月期间在我院接受“八爪鱼”技术治疗的所有患者。共纳入 10 例（8 例男性）患者。平均年龄为 54.5±14.2 岁（范围：31-80 岁）。8 例因动脉瘤破裂或即将破裂而接受急诊修复。所有病例均成功完成了计划中的所有内置物放置，定义为技术成功。共成功穿刺 30 个目标内脏分支，9 个内脏动脉被有意覆盖。术中发现 6 例内漏，均为沟漏。住院期间无死亡，无分支闭塞或脊髓缺血。中位随访时间为 30 个月（范围：12-50 个月）。1 例患者在 14 个月随访时死于肺癌。无二次内漏。3 例患者在 7 天、3 个月和 1 年影像学检查时发现原发性内漏自发缓解。1 例持续性内漏在 4 个月随访时通过密封沟隙完全缓解。另 2 例持续性内漏在随访过程中减少，仍在观察中。分支通畅率为 90.3%（28/31）。所有闭塞的分支均为肾动脉。1 例患者在 1 个月随访时和 1 例患者在 2 年随访时发生分支闭塞，但这些患者均未出现肾功能不全。所有患者均观察到明显的瘤腔缩小（≥5mm）。瘤腔大小从 7.6±1.9cm 缩小至 5.5±1.4cm。随访过程中无脊髓缺血发生。
在没有覆膜支架和分支支架的情况下，对于高手术风险的患者，使用“八爪鱼”技术治疗破裂的 TAAA 和 PRAAA 是可行和安全的。需要进一步研究其长期临床效果。
