Hauck Sven R, Kupferthaler Alexander, Freund Martin C, Pichler Peter, Stelzmüller Marie-Elisabeth, Burghuber Christopher, Ehrlich Marek, Teufelsbauer Harald, Loewe Christian, Funovics Martin A
Division of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz & Medical Faculty, Johannes Kepler University, Linz, Austria.
Insights Imaging. 2022 Mar 28;13(1):62. doi: 10.1186/s13244-022-01196-6.
To present a case series of spontaneous structural failure of bridging stentgrafts (BSGs) after branched endovascular aortic repair (bEVAR), as well as their failure types and their detection. While bEVAR is a safe and effective procedure, one main limitation is the reintervention rate associated with the BSGs. Structural failure of BSGs, defined as fabric disruption, stent fracture with leak or complete separation is a major cause for reinterventions and difficult to detect in computed tomography angiography (CTA).
From a multicenter bEVAR complication database, structural BSG failures were identified. Patient and BSG characteristics, detection mode, failure type, treatment and outcome were recorded and compared with bEVAR patients with intact BSGs.
Twenty-three BSG failures were detected in 12 patients with only 43% directly identified in CTA, after a mean of 21.4 months after implantation. The BSGs were Advanta (n = 4), E-Ventus (n = 16) and BeGraft (n = 3) in 10 renal, 9 superior mesenteric, and 4 celiac branches. Religning with another BSG was successful in 20/22 cases, one BSG failure necessitated renal branch embolization (organ loss), and one mesenteric bypass surgery. Two reintervention-related mortalities occurred.
Structural failure of BSGs is a serious limitation for bEVAR, which can result in high reintervention rates and serious complications. BSG failure typically occurs in single-layer types and events are clustered in patients. The necessary reinterventions carry serious morbidity and mortality. Since the use as BSG in bEVAR is off-label with all current BSG manufacturers, caution is advised regarding patient-informed consent.
介绍一组分支型血管腔内主动脉修复术（bEVAR）后桥接支架移植物（BSG）发生自发性结构失效的病例系列，以及其失效类型和检测方法。虽然bEVAR是一种安全有效的手术，但一个主要限制是与BSG相关的再次干预率。BSG的结构失效定义为织物破裂、伴有渗漏或完全分离的支架断裂，是再次干预的主要原因，且在计算机断层扫描血管造影（CTA）中难以检测到。
从一个多中心bEVAR并发症数据库中识别出BSG的结构失效情况。记录患者和BSG的特征、检测方式、失效类型、治疗方法及结果，并与BSG完整的bEVAR患者进行比较。
在12例患者中检测到23例BSG失效，植入后平均21.4个月，其中CTA直接识别出的仅占43%。BSG包括Advanta（n = 4）、E-Ventus（n = 16）和BeGraft（n = 3），分别用于10个肾动脉分支、9个肠系膜上动脉分支和4个腹腔干分支。22例中的20例成功更换了另一个BSG，1例BSG失效需要进行肾动脉分支栓塞（器官丧失），1例需要进行肠系膜旁路手术。发生了2例与再次干预相关的死亡。
BSG的结构失效是bEVAR的一个严重限制，可导致高再次干预率和严重并发症。BSG失效通常发生在单层类型中，且事件在患者中呈聚集性。必要的再次干预会带来严重的发病率和死亡率。由于目前所有BSG制造商将其用于bEVAR均属于超适应症使用，建议在患者知情同意方面谨慎行事。
