Ye Kaichuang, Qiu Peng, Qin Jinbao, Peng Zhiyou, Li Weimin, Yin Minyi, Lu Xinwu
Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China.
Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Vascular Center of Shanghai JiaoTong University, Shanghai, China.
J Vasc Surg. 2023 Jan;77(1):129-135. doi: 10.1016/j.jvs.2022.07.174. Epub 2022 Aug 6.
The purpose of the present study was to evaluate the technical and short-term clinical outcomes of internal iliac artery (IIA) reconstruction during endovascular aortic repair (EVAR) with in situ laser-assisted fenestration in cases of abdominal aortic aneurysm (AAA) in which the iliac artery is unfit for an internal branched device (IBD).
In the present single-institution retrospective study, we analyzed patients with AAAs who had undergone EVAR with in situ laser-assisted fenestration for IIA reconstruction between January 2018 and April 2021. The study included patients with iliac artery anatomy unfit for the use of commercial IBDs. The primary safety end point was freedom from major adverse events and unplanned reinterventions within 30 days. The primary efficacy end point was freedom from IIA restenosis, reintervention, and symptoms due to pelvic ischemia at 1 year after the procedure.
A total of 20 patients requiring IIA reconstruction but with anatomy unfit for IBD placement were treated with in situ laser-assisted fenestration during EVAR for aortoiliac aneurysms during the study period. The mean age of our patients was 72 years, and 90% were men. The technical success rate was 100%. No patient had died within 30 days after the procedure. A suspicious IIA perforation had occurred in one patient, which was treated with an additional covered stent, for a primary safety end point of 95.0%. After a mean follow-up of 11 months, all except for one of the reconstructed IIAs were patent. Three patients reported symptoms of buttock claudication on the IIA occluded side at their 3-month follow-up after the procedure. However, these symptoms had subsided in two of these patients at 6 months. Type II endoleaks without sac expansion had occurred in two patients owing to retrograde blood flow from the inferior mesenteric artery and lumbar artery. Both patients were kept under close surveillance. The rate of freedom from major adverse events and unplanned reinterventions within 30 days (primary efficacy end point) was 86.3% at 1 year after procedure.
In situ laser-assisted fenestration was found to be a safe and effective alternative method for IIA reconstruction during EVAR for aortoiliac aneurysms in patients with anatomy unfit for IBD.
本研究旨在评估在腹主动脉瘤（AAA）患者中，当髂动脉不适合使用内置分支装置（IBD）时，在血管腔内主动脉修复术（EVAR）期间采用原位激光辅助开窗技术重建髂内动脉（IIA）的技术及短期临床效果。
在本单中心回顾性研究中，我们分析了2018年1月至2021年4月期间接受EVAR联合原位激光辅助开窗技术重建IIA的AAA患者。研究纳入了髂动脉解剖结构不适合使用商用IBD的患者。主要安全终点是术后30天内无重大不良事件和计划外再次干预。主要疗效终点是术后1年无IIA再狭窄、再次干预以及盆腔缺血引起的症状。
在研究期间，共有20例需要重建IIA但解剖结构不适合放置IBD的患者在EVAR治疗主髂动脉瘤时接受了原位激光辅助开窗技术。患者的平均年龄为72岁，90%为男性。技术成功率为100%。术后30天内无患者死亡。1例患者发生可疑的IIA穿孔，经额外植入覆膜支架治疗，主要安全终点率为95.0%。平均随访11个月后，除1例重建的IIA外，其余均通畅。3例患者在术后3个月随访时报告了IIA闭塞侧臀部间歇性跛行症状。然而，其中2例患者在6个月时这些症状已缓解。2例患者因肠系膜下动脉和腰动脉的逆向血流出现无瘤体增大的II型内漏。2例患者均接受密切监测。术后1年，术后30天内无重大不良事件和计划外再次干预的发生率（主要疗效终点）为86.3%。
对于解剖结构不适合IBD的主髂动脉瘤患者，原位激光辅助开窗技术是EVAR期间重建IIA的一种安全有效的替代方法。
