Ohmori Takahiro, Hiraoka Arudo, Chikazawa Genta, Yoshitaka Hidenori
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Ann Vasc Surg. 2023 Jan;88:300-307. doi: 10.1016/j.avsg.2022.06.098. Epub 2022 Jul 31.
Late open conversion has sometimes been required for sac enlargement after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. Though the open repair with endograft preservation is considered less invasive compared to endograft removal, the mid-term outcomes are still unclear. The aim of this study is to evaluate the mid-term outcomes of late open conversion with endograft preservation after EVAR.
We reviewed patients who underwent late open conversion with endograft preservation for sac enlargement or rupture in our institution from May 2007 to December 2020. The open repair mainly consisted of ligation of lumber arteries or the median sacral artery and sacotomy. We additionally performed wrapping of plicated aneurysm with equine pericardium as much as possible. Patients were followed-up by a computed tomography scan and duplex ultrasound 1 and 6 months postoperatively, and each year thereafter.
Of the 1,087 patients who underwent EVAR, 23 patients with a mean age of 81.5 years were included in this study. The mean duration post-EVAR was 35.6 months. Sac wrapping with equine pericardium was performed in 14 patients (60.9%). We additionally performed wrapping of the endograft junction by a Dacron knitted fabric in 1 case with type III endoleak and aortic neck banding in 4 cases with type I endoleak. The 30-day mortality was 0% and the rate of major complications was 4%. All-cause mortality was 21.7% which included 1 aneurysm-related death during a mean follow-up of 38.5 months. Sac re-enlargement was observed in 4 patients without the wrapping method. At 3 years, the aneurysmal diameter in the nonwrapping group significantly increased, compared with the wrapping group (P = 0.011).
Late open conversion with endograft preservation is a feasible treatment; however, at times re-enlargement of the sac aneurysm occurs. The wrapping method has the potential to prevent sac re-enlargement after open conversion.
腹主动脉瘤血管内修复术（EVAR）后，有时需要进行晚期开放转换以处理瘤体增大的情况。虽然保留人工血管的开放修复术与移除人工血管相比被认为侵入性较小，但其中期结果仍不明确。本研究的目的是评估EVAR后保留人工血管的晚期开放转换的中期结果。
我们回顾了2007年5月至2020年12月在我院接受保留人工血管的晚期开放转换以处理瘤体增大或破裂的患者。开放修复主要包括结扎腰动脉或骶中动脉以及瘤体切开术。我们还尽可能多地用马心包包裹折叠后的动脉瘤。术后1个月和6个月以及此后每年通过计算机断层扫描和双功超声对患者进行随访。
在1087例行EVAR的患者中，本研究纳入了23例平均年龄为81.5岁的患者。EVAR后的平均时间为35.6个月。14例患者（60.9%）进行了马心包包裹瘤体。对于1例III型内漏患者，我们还用涤纶针织织物额外包裹了人工血管连接处；对于4例I型内漏患者，进行了主动脉颈部绑扎。30天死亡率为0%，主要并发症发生率为4%。全因死亡率为21.7%，其中包括在平均38.5个月的随访期间1例与动脉瘤相关的死亡。4例未采用包裹方法的患者出现瘤体重新增大。3年时，未包裹组的动脉瘤直径与包裹组相比显著增加（P = 0.011）。
保留人工血管的晚期开放转换是一种可行的治疗方法；然而，有时动脉瘤瘤体会再次增大。包裹方法有可能防止开放转换后瘤体重新增大。
