Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA.
Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA.
J Vasc Surg. 2023 Apr;77(4):975-981. doi: 10.1016/j.jvs.2022.11.041. Epub 2022 Nov 13.
In the present study, we have described the technical success using Fiber Optic RealShape (FORS) endovascular guidance and its effects on the overall procedural time and radiation usage during complex endovascular aortic repair (EVAR).
Fenestrated and branched EVARs performed at a single center from 2017 to 2022 were prospectively studied. FORS-guided procedures were matched retrospectively 1:3 to non-FORS-guided procedures by the incorporated target arteries and body mass index. Technical success was defined as successful target vessel cannulation using FORS for the entirety of navigation (wire insertion to exchange for a stiff wire). The predictors of technical success were evaluated via logistic regression. The procedural times and radiation doses were compared between the matched cohorts using the Wilcoxon rank sum test.
A total of 21 FORS-guided procedures were matched to 61 non-FORS-guided procedures. A total of 95 FORS cannulations were attempted (87 for the visceral target artery and 8 for the bifurcate gate). Technical success was achieved in 81 cannulations (85%); 15 (16%) were completed without the use of live fluoroscopy. The univariate predictors of FORS technical success included <50% target artery stenosis, <50% target artery calcification, and the target vessel attempted (P < .05 for each). FORS failures were attributed to device material properties in six cases, device failure in two cases, and the wire/catheter combination in six. The use of FORS guidance was associated with shorter median procedural and fluoroscopy times and a lower dose area product and air kerma (P ≤ .0001 for each).
The results from our initial experience with FORS during complex EVAR, including our learning curve, has shown promise, with acceptable technical success and reductions in procedural times and radiation usage.
在本研究中，我们描述了使用光纤真实形状（FORS）血管内引导的技术成功，并探讨了其对复杂血管内主动脉修复（EVAR）过程中整体手术时间和辐射使用的影响。
前瞻性研究了 2017 年至 2022 年在一家中心进行的开窗和分支 EVAR。通过纳入的靶血管和体重指数，将 FORS 引导的手术与非 FORS 引导的手术进行回顾性 1:3 匹配。技术成功定义为使用 FORS 成功进行靶血管插管，用于导航的全过程（插入导丝至交换为硬导丝）。通过逻辑回归评估技术成功的预测因素。使用 Wilcoxon 秩和检验比较匹配队列的手术时间和辐射剂量。
共进行了 21 例 FORS 引导的手术，与 61 例非 FORS 引导的手术进行了匹配。共尝试了 95 次 FORS 插管（87 次用于内脏靶动脉，8 次用于分叉门）。81 次插管（85%）实现了技术成功；15 次（16%）未使用实时荧光透视完成。FORS 技术成功的单因素预测因素包括<50%的靶动脉狭窄、<50%的靶动脉钙化和尝试的靶血管（每项 P<0.05）。FORS 失败归因于六例器械材料特性、两例器械故障和六例导丝/导管组合。使用 FORS 引导与更短的中位数手术和透视时间以及更低的剂量面积乘积和空气比释动能相关（每项 P≤0.0001）。
我们在复杂 EVAR 中使用 FORS 的初步经验，包括我们的学习曲线，表明其具有良好的技术成功率，并减少了手术时间和辐射使用。
Zotero 插件