44例患者接受分支型腔内修复术的单中心初步经验。
Single-center initial experience with inner-branch complex EVAR in 44 patients.
作者信息
Kapalla Marvin, Busch Albert, Lutz Brigitta, Nebelung Heiner, Wolk Steffen, Reeps Christian
机构信息
Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus Dresden at the Technical University Dresden, Dresden, Germany.
Institute and Polyclinic for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden at the Technical University Dresden, Dresden, Germany.
出版信息
Front Cardiovasc Med. 2023 Jun 15;10:1188501. doi: 10.3389/fcvm.2023.1188501. eCollection 2023.
PURPOSE
The use of inner-branch aortic stent grafts in the treatment of complex aortic pathologies aims at broad applicability and stable bridging stent sealing compared to other endovascular technologies. The objective of this study was to evaluate the early outcomes with a single manufacturer custom-made and off-the-shelf inner-branched endograft in a mixed patient cohort.
METHODS
This retrospective, monocentric study between 2019 and 2022 included 44 patients treated with inner-branched aortic stent grafts (iBEVAR) as custom-made device (CMD) or off-the-shelf device (E-nside) with at least four inner branches. The primary endpoints were technical and clinical success.
RESULTS
Overall, 77% ( = 34) and 23% ( = 10) of the patients (mean age 77 ± 6.5 years, = 36 male) were treated with a custom-made iBEVAR with at least four inner branches and an off-the-shelf graft, respectively. Treatment indications were thoracoabdominal pathologies in 52.2% ( = 23), complex abdominal aneurysms in 25% ( = 11), and type Ia endoleaks in 22.7% ( = 10). Preoperative spinal catheter placement was performed in 27% ( = 12) of patients. Implantation was entirely percutaneous in 75% ( = 33). Technical success was 100%. Target vessel success manifested at 99% (178/180). There was no in-hospital mortality. Permanent paraplegia developed in 6.8% ( = 3) of patients. The mean follow-up was 12 months (range 0-52 months). Three late deaths (6.8%) occurred, one related to an aortic graft infection. Kaplan-Meier estimated 1-year survival manifested at 95% and branch patency at 98% (177/180). Re-intervention was necessary for a total of six patients (13.6%).
CONCLUSIONS
Inner-branch aortic stent grafts provide a feasible option for the treatment of complex aortic pathologies, both elective (custom-made) and urgent (off-the-shelf). The technical success rate is high with acceptable short-term outcomes and moderate re-intervention rates comparable to existing platforms. Further follow-up will evaluate long-term outcomes.
目的
与其他血管内技术相比，使用分支型主动脉覆膜支架治疗复杂主动脉病变旨在实现广泛适用性和稳定的桥接支架密封。本研究的目的是评估在一个混合患者队列中使用单一制造商定制和现货供应的分支型腔内移植物的早期结果。
方法
这项2019年至2022年的回顾性单中心研究纳入了44例接受分支型主动脉覆膜支架（iBEVAR）治疗的患者，这些支架为定制装置（CMD）或具有至少四个内分支的现货装置（E-nside）。主要终点为技术成功和临床成功。
结果
总体而言，分别有77%（n = 34）和23%（n = 10）的患者（平均年龄77±6.5岁，n = 36例男性）接受了具有至少四个内分支的定制iBEVAR和现货移植物治疗。治疗适应症包括胸腹部病变52.2%（n = 23）、复杂腹主动脉瘤25%（n = 11）和Ia型内漏22.7%（n = 10）。27%（n = 例12）的患者术前进行了脊髓导管置入。75%（n = 33）的植入完全通过经皮方式进行。技术成功率为100%。目标血管成功率为99%（178/180）。无院内死亡。6.8%（n = 3）的患者发生永久性截瘫。平均随访时间为12个月（范围0 - 52个月）。发生了3例晚期死亡（6.8%），1例与主动脉移植物感染有关。Kaplan-Meier估计1年生存率为95%，分支通畅率为98%（177/180）。共有6例患者（13.6%）需要再次干预。
结论
分支型主动脉覆膜支架为治疗复杂主动脉病变提供了一种可行的选择，包括择期（定制）和急诊（现货）。技术成功率高，短期结果可接受，再干预率适中，与现有平台相当。进一步随访将评估长期结果。
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