Vascular Center, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden -
Department of Clinical Sciences Malmö, University of Lund, Lund, Sweden -
Int Angiol. 2022 Oct;41(5):365-371. doi: 10.23736/S0392-9590.22.04915-X. Epub 2022 Jun 15.
The aim of this study was to evaluate the feasibility and efficacy of a modified delivery system of the distal bifurcated FEVAR component where the dilator tip was shortened to prevent damage to the renovisceral bridging stents.
All consecutive patients from a tertiary referral center that underwent a FEVAR with a custom delivery system of the distal bifurcated endograft with a short tip between November 2017 and July 2019 were retrospectively analyzed. Only patients with complete fluoroscopic loops of the insertion and deployment of the distal endograft were included. The primary study endpoint was the degree of crossing of the fenestration bridging stent-grafts, that was graded as 'not crossing', 'partial crossing' and 'complete crossing' relative to the lowermost placed fenestration. Secondary endpoints included fenestration related adverse events, secondary interventions, changes in renal function, aneurysm related mortality and overall mortality.
23 patients were included (21 (91%) juxta-renal aneurysms, 2 TAAA type IV (9%). The lowermost fenestration was crossed in 4 (17.3%), partially crossed in 9 (39.1%) and not crossed in 10 (43.4%) cases. Partial compression or inadequate flaring of a fenestration stent-graft was identified in the intraoperative cone beam CT in 6 (26.0%) patients and corrected peri-operatively. Technical success was 100%. Median follow-up was 34 (27-38) months with two non-aneurysm related deaths during this period. Four patients (17.3%) underwent a secondary intervention related to a fenestration bridging stent-graft.
The use of a custom short dilator introducer tip on the bifurcated device during FEVAR reduces the need to cross the fenestration bridging stent-grafts and may result in less fenestration related adverse events. However, the reno-visceral segment is still frequently crossed by the iliac extension which may lead to adverse events. This could likely be avoided by a similar adaptation on the iliac extension delivery system.
本研究旨在评估改良分叉式 FEVAR 组件输送系统的可行性和疗效，该系统的扩张器尖端缩短，以防止损伤内脏吻合支架。
回顾性分析 2017 年 11 月至 2019 年 7 月期间在三级转诊中心接受定制分叉式覆膜支架输送系统治疗的所有连续患者。仅纳入有完整的远端分叉型覆膜支架插入和展开透视循环的患者。主要研究终点是开窗支架-移植物的交叉程度，分为“未交叉”、“部分交叉”和“完全交叉”，相对最低的开窗位置。次要终点包括与开窗相关的不良事件、二次干预、肾功能变化、动脉瘤相关死亡率和总死亡率。
23 例患者入组（21 例（91%）为肾下型动脉瘤，2 例 TAAA 型 IV 期（9%））。4 例（17.3%）患者的最低开窗完全交叉，9 例（39.1%）部分交叉，10 例（43.4%）未交叉。术中锥形束 CT 发现 6 例（26.0%）患者存在开窗支架-移植物部分压缩或扩张不足，并在围手术期进行了纠正。技术成功率为 100%。中位随访时间为 34（27-38）个月，在此期间有 2 例非动脉瘤相关死亡。4 例（17.3%）患者因开窗吻合支架-移植物行二次干预。
在 FEVAR 中使用分叉式器械的定制短扩张器导入器尖端可减少交叉开窗支架-移植物的需要，并可能减少与开窗相关的不良事件。然而，肾-内脏段仍经常被髂内延伸段交叉，这可能导致不良事件。这可能通过类似的髂内延伸输送系统的适应性改变来避免。
