Hyun Sangho, Kim Hojung, Mok Sang Kyun, Yun Sang Seob, Park Sun Cheol, Kim Jang Yong
Department of Vascular and Transplant Surgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.
Ann Surg Treat Res. 2023 Jan;104(1):34-42. doi: 10.4174/astr.2023.104.1.34. Epub 2023 Jan 2.
This study aims to investigate the feasibility of Zenith Fenestrated AAA Endovascular Graft (Z-FEN, Cook Medical) from a single Korean institution database by evaluating the vascular anatomy of Korean abdominal aortic aneurysm (AAA) patients with hostile aortic neck.
This is a retrospective study on patients with AAA who underwent endovascular aortic repair (EVAR) and open surgery repair between January 2012 and December 2021 (n = 211). The anatomic characteristics of the aortic neck were evaluated using 3-dimensional reconstructed computed tomographic scans. For the juxtarenal AAA patients (n = 39), feasibility of fenestrated stent graft was evaluated under the protocol of fenestrated EVAR. For those who were not suitable for the application of Z-FEN, the reasons for unsuitability were analyzed.
Among 211 AAA patients, 108 patients (51.2%) had complex aortic neck, and 39 (18.5%) had insufficient aortic neck length (<15 mm) for conventional EVAR. Of the 39 patients with juxtarenal AAAs, 13 (33.3%) were determined feasible for Z-FEN. Twenty-six patients (66.7%) were noncandidate for Z-FEN due to severe neck angulation, short aortic neck length, inadequate iliac artery anatomy, large aortic neck diameter, and severe calcification and thrombosis. Proximal aortic neck length of the non-feasible group was significantly shorter than that of the feasible group (P = 0.002).
Z-FEN was applicable to 33.3% of the juxtarenal AAA patients. As recent studies confirm, the effectiveness and safety of fenestrated EVAR, Z-FEN can be an option for AAA patients with short aortic neck.
本研究旨在通过评估韩国腹主动脉瘤（AAA）合并主动脉颈部病变患者的血管解剖结构，从韩国单一机构数据库中研究Zenith开窗型AAA腔内移植物（Z-FEN，库克医疗公司）的可行性。
这是一项对2012年1月至2021年12月期间接受血管腔内主动脉修复术（EVAR）和开放手术修复的AAA患者的回顾性研究（n = 211）。使用三维重建计算机断层扫描评估主动脉颈部的解剖特征。对于近肾型AAA患者（n = 39），在开窗型EVAR方案下评估开窗支架型人工血管的可行性。对于不适合应用Z-FEN的患者，分析其不适合的原因。
在211例AAA患者中，108例（51.2%）有复杂的主动脉颈部，39例（18.5%）主动脉颈部长度不足（<15 mm），不适合传统EVAR。在39例近肾型AAA患者中，13例（33.3%）被确定适合使用Z-FEN。26例（66.7%）患者因严重的颈部成角、主动脉颈部长度短、髂动脉解剖结构不佳、主动脉颈部直径大以及严重钙化和血栓形成而不适合使用Z-FEN。不可行组的近端主动脉颈部长度明显短于可行组（P = 0.002）。
Z-FEN适用于33.3%的近肾型AAA患者。正如最近的研究所证实的，开窗型EVAR的有效性和安全性，Z-FEN可以作为主动脉颈部短的AAA患者的一种选择。
