Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.
Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, 34149, Trieste, TS, Italy.
Cardiovasc Intervent Radiol. 2022 Jul;45(7):939-949. doi: 10.1007/s00270-022-03166-3. Epub 2022 Jun 2.
The aim of the study was to evaluate outcomes after bilateral implantation of the Gore Excluder Iliac Branch Endoprosthesis (IBE) versus those achieved after unilateral implantation.
All consecutive patients electively treated in a single center for aorto-iliac aneurysm using the IBE device between January 1, 2014, and December 31, 2018, were reviewed. Early outcome measures were technical success, 30 days or in-hospital mortality, and major adverse events (MAE). Late outcome measures were survival, internal iliac artery (IIA) patency, and freedom from IIA branch instability.
A total of 74 patients (97% males, mean age 74 ± 7 years) were included. Thirteen patients (17%) received bilateral IBE implantation for a total of 85 vessels evaluated. The technical success rate was 97% and was not significantly different between the two groups (p = .32). Two patients died within 30 days, both in the unilateral group (p = 1). No significant differences were seen in the rates of 30 days MAE (p = .10). At one year, the overall survival rate was 95 ± 2% vs 90 ± 3% in the unilateral and bilateral group, respectively (Log-rank = .05). There were no differences in 1-year primary and secondary patency rates between groups (Log-rank = .75 and Log-rank = .34, respectively). Freedom from IIA branch instability at one year was also not significantly different (unilateral: 94 ± 3% vs. bilateral: 82 ± 9%, Log-rank = .22)..
Bilateral IBE use for elective endovascular treatment of aorto-iliac aneurysms appears safe and feasible and may achieve satisfactory short-term and mid-term outcomes. Bilateral IBE use should be employed judiciously in the context of a comprehensive risk/benefit evaluation.
本研究旨在评估 Gore Excluder 髂支覆膜支架（IBE）双侧植入与单侧植入的治疗效果。
回顾性分析 2014 年 1 月 1 日至 2018 年 12 月 31 日期间在单中心接受 IBE 装置治疗的腹主动脉-髂动脉瘤患者的连续病例。早期结果评估包括技术成功率、30 天或住院期间死亡率以及主要不良事件（MAE）。晚期结果评估包括生存率、髂内动脉（IIA）通畅率以及 IIA 分支稳定性。
共纳入 74 例患者（97%为男性，平均年龄 74±7 岁）。13 例患者（17%）接受双侧 IBE 植入，共评估 85 支血管。技术成功率为 97%，两组之间无显著差异（p=0.32）。2 例患者在 30 天内死亡，均为单侧组（p=1）。30 天 MAE 发生率无显著差异（p=0.10）。1 年时，总生存率分别为单侧组 95±2%和双侧组 90±3%（Log-rank=0.05）。两组间 1 年的一期和二期通畅率无差异（Log-rank=0.75 和 Log-rank=0.34）。1 年时 IIA 分支稳定性无显著差异（单侧组：94±3%，双侧组：82±9%，Log-rank=0.22）。
双侧 IBE 用于治疗腹主动脉-髂动脉瘤的选择性血管内治疗是安全可行的，可能获得满意的短期和中期效果。双侧 IBE 的使用应在综合风险/获益评估的背景下谨慎考虑。
