Biggs Joedd H, Tenorio Emanuel R, DeMartino Randall R, Oderich Gustavo S, Mendes Bernardo C
Advanced Endovascular Aortic Research Program, Mayo Clinic, Rochester, MN.
Advanced Aortic Research Program, University of Texas Health Science, Houston, TX.
Ann Vasc Surg. 2022 Sep;85:87-95. doi: 10.1016/j.avsg.2022.05.003. Epub 2022 May 17.
To evaluate outcomes following urgent or emergent fenestrated-branched endovascular aortic repair (F-BEVAR) for pararenal (PRA) and thoracoabdominal aortic aneurysms (TAAA) in patients who are considered high-risk for open repair.
A retrospective, single institution evaluation of outcomes following F-BEVAR of symptomatic, rapidly enlarging, or ruptured PRA or TAAA treated with physician modified endograft (PMEG) and company manufactured devices (CMD). Outcomes were technical success, 30-day morbidity and mortality, and 1 year aortic related outcomes.
Thirty-two patients (23 male, mean age, 74 ± 9 years) underwent F-BEVAR using PMEG or CMD over a 12-year period. Fourteen patients underwent emergent repair for contained rupture and 18 patients underwent urgent repair for symptomatic, mycotic, or rapidly growing aneurysms. Aneurysm classification was PRA in 10 patients and TAAA in 22 (9 extent IV and 13 extent I-III). Twenty-three patients (72%) were repaired with PMEG and 8 patients (26%) with CMD. Technical success was 97% with a total of 98 renal-mesenteric arteries incorporated using 67 fenestrations (68%), 29 directional branches (29%), and 2 double-wide scallops (2%). A 30-day mortality was 6%, with 1 patient expiring from unclear causes after hospital discharge and the other from mesenteric ischemia. Mortality and major adverse events MAEs otherwise occurred in 16 patients (50%), including minor stroke in 3 patients, transient paraparesis and heart failure in 1 patient each, and early return to the operating room in 6 patients. Mean follow-up was 24 ± 22 months. At 1-year, overall survival, freedom from aortic-related mortality and freedom from secondary intervention were 70% ± 8%, 94% ± 3 and 83% ± 7, respectively.
Urgent F-BEVAR of selected patients with PRA and TAAA is a feasible and potentially safe treatment in patients with suitable anatomy, with low rates of early mortality and spinal cord complications. Long-term follow-up is needed to assess the durability of repair and device-related complications.
评估在接受开放性修复手术风险较高的患者中，采用紧急或急诊开窗分支型血管腔内主动脉修复术（F-BEVAR）治疗肾周（PRA）和胸腹主动脉瘤（TAAA）后的疗效。
对采用医生改良型移植物（PMEG）和公司生产的器械（CMD）治疗有症状、快速增大或破裂的PRA或TAAA进行F-BEVAR后的疗效进行回顾性单机构评估。疗效指标包括技术成功率、30天发病率和死亡率以及1年主动脉相关结局。
在12年期间，32例患者（23例男性，平均年龄74±9岁）接受了使用PMEG或CMD的F-BEVAR手术。14例患者因局限性破裂接受急诊修复，18例患者因有症状、霉菌性或快速生长的动脉瘤接受紧急修复。动脉瘤分类为10例PRA和22例TAAA（9例IV型和13例I-III型）。23例患者（72%）采用PMEG修复，8例患者（26%）采用CMD修复。技术成功率为97%，共使用67个开窗（68%）、29个定向分支（29%）和2个双宽扇贝（2%）合并了98条肾肠系膜动脉。30天死亡率为6%，1例患者出院后不明原因死亡，另1例死于肠系膜缺血。死亡率和主要不良事件（MAE）在其他16例患者（50%）中发生，包括3例轻微中风、1例短暂性截瘫和1例心力衰竭，以及6例患者早期返回手术室。平均随访时间为24±22个月。1年时，总生存率、无主动脉相关死亡率和无二次干预率分别为70%±8%、94%±3和83%±7。
对于选定的PRA和TAAA患者，紧急F-BEVAR在解剖结构合适的患者中是一种可行且可能安全的治疗方法，早期死亡率和脊髓并发症发生率较低。需要长期随访以评估修复的耐久性和器械相关并发症。
