Verhagen Merel, Eefting Daniel, van Rijswijk Carla, van der Meer Rutger, Hamming Jaap, van der Vorst Joost, van Schaik Jan
Department of Vascular Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
J Clin Med. 2023 Jul 26;12(15):4921. doi: 10.3390/jcm12154921.
Perioperative risk assessments for complex aneurysms are based on the anatomical extent of the aneurysm and do not take the length of the aortic exclusion into account, as it was developed for open repair. Nevertheless, in the endovascular repair (ER) of complex aortic aneurysms, additional segments of healthy aorta are excluded compared with open repair (OR). The aim of this study was to assess differences in aortic exclusion between the ER and OR of complex aortic aneurysms, to subsequently assess the current classification for complex aneurysm repair.
This retrospective observational study included patients that underwent complex endovascular aortic aneurysm repair by means of fenestrated endovascular aneurysm repair (FEVAR), fenestrated and branched EVAR (FBEVAR), or branched EVAR (BEVAR). The length of aortic exclusion and the number of patent segmental arteries were determined and compared per case in ER and hypothetical OR, using a Wilcoxon signed-rank test.
A total of 71 patients were included, who were treated with FEVAR (n = 44), FBEVAR (n = 8), or BEVAR (n = 19) for Crawford types I (n = 5), II (n = 7), III (n = 6), IV (n = 7), and V (n = 2) thoracoabdominal or juxtarenal (n = 44) aneurysms. There was a significant increase in the median exclusion of types I, II, III, IV, and juxtarenal aneurysms ( < 0.05) in ER, compared with hypothetical OR. The number of patent segmental arteries in the ER of type I-IV and juxtarenal aneurysms was significantly lower than in hypothetical OR ( < 0.05).
There are significant differences in the length of aortic exclusion between ER and hypothetical OR, with the increased exclusion in ER resulting in a lower number of patent segmental arteries. The ER and OR of complex aortic aneurysms should be regarded as distinct modalities, and as each approach deserves a particular risk assessment, future efforts should focus on reporting on the extent of exclusion per treatment modality, to allow for appropriate comparison.
复杂动脉瘤的围手术期风险评估基于动脉瘤的解剖范围，且未考虑主动脉阻断长度，因为该评估方法是为开放修复而制定的。然而，在复杂主动脉瘤的血管内修复（ER）中，与开放修复（OR）相比，健康主动脉的额外节段被阻断。本研究的目的是评估复杂主动脉瘤的ER与OR之间主动脉阻断的差异，随后评估复杂动脉瘤修复的当前分类。
这项回顾性观察性研究纳入了通过开窗血管内动脉瘤修复（FEVAR）、开窗分支血管内动脉瘤修复（FBEVAR）或分支血管内动脉瘤修复（BEVAR）进行复杂血管内主动脉瘤修复的患者。使用Wilcoxon符号秩检验，确定并比较每个病例在ER和假设的OR中的主动脉阻断长度和通畅的节段动脉数量。
共纳入71例患者，他们接受了FEVAR（n = 44）、FBEVAR（n = 8）或BEVAR（n = 19）治疗，用于治疗Crawford I型（n = 5）、II型（n = 7）、III型（n = 6）、IV型（n = 7）和V型（n = 2）胸腹或肾旁（n = 44）动脉瘤。与假设的OR相比，ER中I型、II型、III型、IV型和肾旁动脉瘤的中位阻断长度显著增加（< 0.05）。I-IV型和肾旁动脉瘤的ER中通畅的节段动脉数量显著低于假设的OR（< 0.05）。
ER与假设的OR之间在主动脉阻断长度上存在显著差异，ER中阻断长度增加导致通畅的节段动脉数量减少。复杂主动脉瘤的ER和OR应被视为不同的治疗方式，由于每种方法都应进行特定的风险评估，未来的工作应集中于报告每种治疗方式的阻断范围，以便进行适当的比较。
