Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, Rome, Italy.
Vascular and Endovascular Surgery Unit, San Camillo-Forlanini Hospital, Rome, Italy.
J Vasc Surg. 2022 Aug;76(2):326-334. doi: 10.1016/j.jvs.2022.03.007. Epub 2022 Mar 18.
To assess the outcomes of Cook t-Branch off-the-shelf multibranched stent graft in the treatment of complex aortic aneurysms with narrow internal aortic lumen.
Between 2016 and 2020, 48 patients (mean age, 73 years) underwent elective or urgent or emergent Cook t-Branch implantation for thoracoabdominal or para/juxtarenal aortic aneurysms in two Italian vascular centers. Among these, 20 patients presented a paravisceral or pararenal luminal diameter of less than 25 mm. Major clinical and radiologic outcomes of patients with narrow aortic lumen were compared with patients with a larger lumen in a multicenter, nonrandomized, retrospective fashion.
The in-hospital mortality was 10% (5% in the elective setting). Spinal cord ischemia occurred in 6% of the cases. During a mean follow-up of 18 months (range, 1-63 months), late t-Branch procedure-related mortality and the need for reintervention was 0% and 12%, respectively. Comparing the outcomes of patients with large internal aortic lumen (group 1) with patients with small lumen (group 2), no significant difference was found regarding fluoroscopy time (P = .3); technical success (P = 1); early (P = .4) and late (P = 1) mortality; spinal cord ischemia (P = .2); bowel ischemia (P = .5); renal (P = .7), cardiac (P = 1), and respiratory complications (P = 1); reintervention rate (P = 1); and primary patency rate of stented target vessels (P = 1).
The use of the Cook t-Branch in our experience was safe and effective in the treatment of complex aortic aneurysms regardless the caliber of the aortic lumen. With all the limitations of a small sample size, this approach has demonstrated to be feasible when maneuverability is decreased, with low mortality and morbidity, and acceptable reintervention rates. Perioperative mortality remains closely related to clinical presentation. Large-scale studies are needed to confirm these results.
评估库克 t-分支成品分支型覆膜支架在治疗主动脉内腔狭窄的复杂主动脉瘤中的疗效。
2016 年至 2020 年，在意大利的两个血管中心，48 名患者（平均年龄 73 岁）因胸腹主动脉瘤或肾周/肾旁主动脉瘤接受了选择性或紧急或急症库克 t-分支植入术。其中 20 名患者的内脏或肾周管腔直径小于 25mm。采用多中心、非随机、回顾性的方法，比较了主动脉管腔狭窄患者与管腔较大患者的主要临床和影像学结果。
住院死亡率为 10%（择期组为 5%）。脊髓缺血的发生率为 6%。平均随访 18 个月（1-63 个月）期间，t-分支相关迟发性死亡率和再介入率分别为 0%和 12%。比较主动脉内腔较大的患者（第 1 组）和内腔较小的患者（第 2 组）的结果，两组在透视时间（P=0.3）、技术成功率（P=1）、早期（P=0.4）和晚期（P=1）死亡率、脊髓缺血（P=0.2）、肠缺血（P=0.5）、肾（P=0.7）、心（P=1）和呼吸并发症（P=1）、再介入率（P=1）和支架靶血管的一期通畅率（P=1）方面均无显著差异。
在我们的经验中，使用库克 t-分支治疗复杂主动脉瘤是安全有效的，与主动脉管腔的口径无关。尽管存在样本量小的所有局限性，但当可操作性降低时，这种方法是可行的，具有低死亡率和发病率，以及可接受的再介入率。围手术期死亡率仍然与临床表现密切相关。需要进行大规模研究来证实这些结果。
Zotero 插件