Bordet Marine, Oliny Alexandre, Miasumu Tiphaine, Tresson Philippe, Lermusiaux Patrick, Della Schiava Nellie, Millon Antoine
Department of Vascular and Endovascular Surgery, Hospices Civils de Lyon, Louis Pradel University Hospital, Bron, France; Université Claude Bernard Lyon 1, F-69621, Villeurbanne, France.
Department of Vascular and Endovascular Surgery, Hospices Civils de Lyon, Louis Pradel University Hospital, Bron, France.
J Vasc Surg. 2023 Jan;77(1):28-36.e3. doi: 10.1016/j.jvs.2022.08.035. Epub 2022 Sep 5.
The aim of this study was to compare midterm results of EndoAnchors in EndoSuture aneurysm repair (ESAR) versus fenestrated endovascular aneurysm repair (FEVAR) in short neck abdominal aortic aneurysm (AAA).
All patients who underwent an ESAR procedure for a short neck AAA at our center between September 2017 and May 2020 were considered for analysis. To form the control group, preoperative computed tomography angiography of patients who underwent FEVAR for juxtarenal AAA between April 2012 and May 2020 were reviewed and patients who met short neck criteria selected. A propensity-matched score on neck length and neck diameter was calculated, resulting in 18 matched pairs. AAA shrinkage, type Ia endoleaks (EL), AAA-related reinterventions, and AAA-related deaths were compared.
The median AAA diameter was 54 mm (interquartile range [IQR], 52-61 mm) versus 58 mm (IQR, 53-63 mm) with a median neck length of 8 mm (IQR, 6-12 mm) vs 10 mm (IQR, 6-13 mm) in ESAR and FEVAR patients, respectively. Technical success was 100% in both groups. Procedural success was 94% in the ESAR group versus 100% in the FEVAR group. The median procedure duration was 138 mm (IQR, 113-182 mm) vs 240 mm (IQR, 199-293 mm) ( P < .001) and the median length of stay was 2 days (IQR, 2-3 days) vs 7 days (IQR, 6-7 days) (P < .001) in ESAR and FEVAR patients, respectively. No major hospital complications were observed in ESAR patients compared with two in FEVAR patients (11%) with one transient acute kidney injury and one transient paraplegia. The median follow-up was 23 months (IQR, 19-33 months) vs 36 months (IQR, 22-57 months) with 67% versus 61% AAA shrinkage in the ESAR and FEVAR groups, respectively (P = .73). No type Ia EL, proximal neck-related reinterventions, or AAA-related deaths were observed in either group. No AAA-related reintervention was observed in the ESAR group versus three reinterventions in the FEVAR group (P = .23).
ESAR seems to be a safe technique with no major postoperative complications or reinterventions observed during follow-up. It seems to offer similar midterm results as FEVAR in terms of type Ia EL, aneurysm shrinkage, and aneurysm-related mortality. ESAR seems to be a good off-the-shelf alternative to FEVAR in case of technical constraints.
本研究旨在比较EndoAnchors在短颈腹主动脉瘤（AAA）的EndoSuture动脉瘤修复术（ESAR）与开窗式血管内动脉瘤修复术（FEVAR）的中期结果。
2017年9月至2020年5月在本中心接受ESAR治疗短颈AAA的所有患者均纳入分析。为形成对照组，回顾了2012年4月至2020年5月接受肾周AAA的FEVAR治疗患者的术前计算机断层扫描血管造影，并选择符合短颈标准的患者。计算颈长和颈径的倾向匹配得分，得到18对匹配对。比较AAA缩小情况、Ia型内漏（EL）、与AAA相关的再次干预以及与AAA相关的死亡情况。
ESAR组和FEVAR组患者的AAA中位直径分别为54 mm（四分位间距[IQR]，52 - 61 mm）和58 mm（IQR，53 - 63 mm），中位颈长分别为8 mm（IQR，6 - 12 mm）和10 mm（IQR，6 - 13 mm）。两组的技术成功率均为100%。ESAR组的手术成功率为94%，FEVAR组为100%。ESAR组和FEVAR组患者的中位手术时间分别为138分钟（IQR，113 - 182分钟）和240分钟（IQR，199 - 293分钟）（P <.001），中位住院时间分别为2天（IQR，2 - 3天）和7天（IQR，6 - 7天）（P <.001）。ESAR组未观察到重大医院并发症，而FEVAR组有两例（11%），分别为一例短暂性急性肾损伤和一例短暂性截瘫。ESAR组和FEVAR组的中位随访时间分别为23个月（IQR，19 - 33个月）和36个月（IQR，22 - 57个月），AAA缩小率分别为67%和61%（P =.73）。两组均未观察到Ia型EL、近端颈部相关的再次干预或与AAA相关的死亡。ESAR组未观察到与AAA相关的再次干预，而FEVAR组有三次再次干预（P =.
