Mirabella Domenico, Evola Salvatore, Dinoto Ettore, Setacci Carlo, Pakeliani David, Setacci Francesco, Annicchiarico Paolo, Pecoraro Felice
Vascular Surgery Unit, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy.
Cardiology Unit, AOUP Policlinico "P. Giaccone", 90127 Palermo, Italy.
J Clin Med. 2023 Sep 28;12(19):6263. doi: 10.3390/jcm12196263.
Endovascular aortic repair (EVAR) is generally performed with bi/trimodular stent-grafts requiring retrograde contralateral gate cannulation (CGC). In the case of tricky CGC, an increased EVAR procedural time and radiation exposure have been reported. Herein, we compare the outcomes of conventional CGC and CGC using the speed gate cannulation (SGC) technique in standard EVAR for a propensity-matched cohort.
A total of 371 patients were retrospectively analyzed. Inclusion criteria were fulfilled in 172 patients who underwent propensity score matching. Primary outcomes included operative time, CGC time, mean contrast medium, fluoroscopy time, and CGC fluoroscopy time.
After matching, 78 patients were included in each group (SGC vs. standard). Primary outcomes registered a significant reduction in CGC time (4 [1-6] vs. 8 [6-14] min; = 0.001) and fluoroscopy time (12 [9-16] vs. 17 [12-25] min).
In this preliminary experiment, the use of SGC was feasible with no significant registered postoperative complications. A significant reduction in contrast medium usage, radiation exposure, and CGC time was observed with the use of SGC. SGC is a simple adjunctive technique, and its use should be considered in standard EVAR, especially in emergency scenarios, where time is of the essence.
血管腔内主动脉修复术（EVAR）通常使用双模块/三模块支架型人工血管进行，需要逆行对侧入路插管（CGC）。在复杂的CGC情况下，已有报道称EVAR手术时间和辐射暴露会增加。在此，我们比较了标准EVAR中传统CGC和使用快速入路插管（SGC）技术的CGC在倾向评分匹配队列中的结果。
对371例患者进行回顾性分析。172例患者符合纳入标准并进行了倾向评分匹配。主要结局包括手术时间、CGC时间、平均造影剂用量、透视时间和CGC透视时间。
匹配后，每组纳入78例患者（SGC组与标准组）。主要结局显示CGC时间（4[1 - 6]分钟对8[6 - 14]分钟；P = 0.001）和透视时间（12[9 - 16]分钟对17[12 - 25]分钟）显著缩短。
在这项初步实验中，使用SGC是可行的，术后未出现明显并发症。使用SGC可显著减少造影剂用量、辐射暴露和CGC时间。SGC是一种简单的辅助技术，在标准EVAR中应考虑使用，尤其是在时间至关重要的紧急情况下。
