Sulzer Titia A L, Macedo Thanila A, Strissel Nicole, Hesley Gina K, Lekah Alexander, Tallarita Tiziano, Dias-Neto Marina, Huang Ying, Tenorio Emanuel R, Vacirca Andrea, Mesnard Thomas, Baghbani-Oskouei Aidin, Savadi Safa, de Bruin Jorg L, Verhagen Hence J M, Mendes Bernardo, Oderich Gustavo S
Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
J Vasc Surg. 2023 Nov;78(5):1162-1169.e2. doi: 10.1016/j.jvs.2023.06.106. Epub 2023 Jul 14.
Stenting of renal and mesenteric vessels may result in changes in velocity measurements due to arterial compliance, potentially giving rise to confusion about the presence of stenosis during follow-up. The aim of our study was to compare preoperative and postoperative changes in peak systolic velocity (PSV, cm/s) after placement of the celiac axis (CA), superior mesenteric artery (SMA) and renal artery (RAs) bridging stent grafts during fenestrated-branched endovascular aortic repair (FB-EVAR) for treatment of complex abdominal aortic aneurysms (AAA) and thoracoabdominal aortic aneurysms.
Patients were enrolled in a prospective, nonrandomized single-center study to evaluate FB-EVAR for treatment of complex AAA and thoracoabdominal aortic aneurysms between 2013 and 2020. Duplex ultrasound examination of renal-mesenteric vessels were obtained prospectively preoperatively and at 6 to 8 weeks after the procedure. Duplex ultrasound examination was performed by a single vascular laboratory team using a predefined protocol including PSV measurements obtained with <60° angles. All renal-mesenteric vessels incorporated by bridging stent grafts using fenestrations or directional branches were analyzed. Target vessels with significant stenosis in the preoperative exam were excluded from the analysis. The end point was variations in PSV poststent placement at the origin, proximal, and mid segments of the target vessels for fenestrations and branches.
There were 419 patients (292 male; mean age, 74 ± 8 years) treated by FB-EVAR with 1411 renal-mesenteric targeted vessels, including 260 CAs, 409 SMAs, and 742 RAs. No significant variances in the mean PSVs of all segments of the CA, SMA, and RAs at 6 to 8 weeks after surgery were found as compared with the preoperative values (CA, 135 cm/s vs 141 cm/s [P = .06]; SMA, 128 cm/s vs 125 cm/s [P = .62]; RAs, 90 cm/s vs 83 cm/s [P = .65]). Compared with baseline preoperative values, the PSV of the targeted vessels showed no significant differences in the origin and proximal segment of all vessels. However, the PSV increased significantly in the mid segment of all target vessels after stent placement.
Stent placement in nonstenotic renal and mesenteric vessels during FB-EVAR is not associated with a significant increase in PSVs at the origin and proximal segments of the target vessels. Although there is a modest but significant increase in velocity measurements in the mid segment of the stented vessel, this difference is not clinically significant. Furthermore, PSVs in stented renal and mesenteric arteries were well below the threshold for significant stenosis in native vessels. These values provide a baseline or benchmark for expected PSVs after renal-mesenteric stenting during FB-EVAR.
肾动脉和肠系膜血管支架置入可能会因动脉顺应性导致速度测量值发生变化，这可能会在随访期间引起对狭窄存在与否的混淆。我们研究的目的是比较在开窗分支血管腔内主动脉修复术（FB-EVAR）治疗复杂腹主动脉瘤（AAA）和胸腹主动脉瘤期间，腹腔干（CA）、肠系膜上动脉（SMA）和肾动脉（RAs）桥接支架置入术前和术后的收缩期峰值速度（PSV，cm/s）变化。
患者纳入一项前瞻性、非随机单中心研究，以评估2013年至2020年间FB-EVAR治疗复杂AAA和胸腹主动脉瘤的情况。术前和术后6至8周前瞻性地进行肾肠系膜血管的双功超声检查。由单一血管实验室团队按照预定义方案进行双功超声检查，包括以<60°角度获得PSV测量值。分析所有通过开窗或定向分支纳入桥接支架的肾肠系膜血管。术前检查有明显狭窄的目标血管被排除在分析之外。终点是开窗和分支目标血管在支架置入后起源处、近端和中段的PSV变化。
419例患者（292例男性；平均年龄74±8岁）接受了FB-EVAR治疗，有1411条肾肠系膜目标血管，包括260条CA、409条SMA和742条RAs。与术前值相比，术后6至8周CA、SMA和RAs各段的平均PSV无显著差异（CA，135 cm/s对141 cm/s [P = 0.06]；SMA，128 cm/s对125 cm/s [P = 0.62]；RAs，90 cm/s对83 cm/s [P = 0.65]）。与术前基线值相比，所有血管起源处和近端的目标血管PSV无显著差异。然而，支架置入后所有目标血管中段的PSV显著增加。
FB-EVAR期间在无狭窄的肾动脉和肠系膜血管中置入支架，目标血管起源处和近端的PSV无显著增加。尽管支架置入血管中段的速度测量值有适度但显著的增加，但这种差异在临床上无显著意义。此外，支架置入的肾动脉和肠系膜动脉的PSV远低于天然血管明显狭窄的阈值。这些值为FB-EVAR期间肾肠系膜支架置入后预期的PSV提供了基线或基准。
