Unit of Vascular and Endovascular Surgery, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy -
Unit of Vascular and Endovascular Surgery, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.
J Cardiovasc Surg (Torino). 2024 Apr;65(2):110-118. doi: 10.23736/S0021-9509.24.13032-7. Epub 2024 Apr 18.
The aim of this study was to evaluate the anatomical feasibility of current available fenestrated endografts (FEVAR) and on-label chimney technique (EnChEVAR) in patients with complex abdominal aortic aneurysms (C-AAA).
Feasibility of EnChEVAR (Endurant II/IIS CE-marked [Medtronic]) and 4 types of FEVAR (Zenith Fenestrated CE-marked, Zenith Fenestrated Low-Profile [LP] custom-made device [CMD] [Cook Medical], Fenestrated Anaconda LoPro90 CMD, Fenestrated Treo CMD [Terumo Aortic]) was assessed according to the manufacturer's instructions for use. Computed tomography angiograms of patients with C-AAA previously included in the Protagoras 2.0 study were retrospectively reviewed. The aortic coverage was ideally planned to involve a maximum of two chimney grafts or fenestrations.
Iliac access and aortic neck of 73 C-AAAs were analyzed. The overall feasibility was significantly different between EnChEVAR (33%) and FEVAR (Zenith Fenestrated 15%, Zenith Fenestrated LP 15%, Fenestrated Anaconda LoPro90 45%, Fenestrated Treo 48%). The iliac access feasibility was significantly lower for Zenith Fenestrated with standard profile compared to all other grafts. The aortic neck feasibility was significantly higher for EnChEVAR and both Terumo Aortic fenestrated stent grafts, compared to both Cook Medical grafts. The treatment using any of the three current available fenestrated grafts with lower profile (Zenith Fenestrated LP, Fenestrated Anaconda LoPro90, Fenestrated Treo) would have been feasible in 71% of the cases.
Most of the patients treated by ChEVAR would have not been treated by first generation fenestrated stent graft. The current available fenestrated endografts, with lower profile and suitable also for angulated necks, increase the anatomical feasibility.
本研究旨在评估当前可用的腔内分支移植物（FEVAR）和经导管烟囱技术（EnChEVAR）在复杂腹主动脉瘤（C-AAA）患者中的解剖可行性。
根据制造商的使用说明，评估 EnChEVAR（Endurant II/IIS CE 标志[美敦力]）和 4 种 FEVAR（Zenith Fenestrated CE 标志，Zenith Fenestrated 低轮廓[LP]定制装置[CMD] [库克医疗]，Fenestrated Anaconda LoPro90 CMD，Fenestrated Treo CMD [泰尔茂主动脉]）的可行性。回顾性分析先前纳入 Protagoras 2.0 研究的 C-AAA 患者的计算机断层血管造影。主动脉覆盖理想地计划涉及最多两个烟囱移植物或开窗。
分析了 73 例 C-AAA 的髂动脉入路和主动脉颈。EnChEVAR（33%）和 FEVAR（Zenith Fenestrated 15%，Zenith Fenestrated LP 15%，Fenestrated Anaconda LoPro90 45%，Fenestrated Treo 48%）之间的总体可行性差异有统计学意义。与所有其他移植物相比，标准口径 Zenith Fenestrated 的髂动脉入路可行性显著降低。与所有 Cook 医疗移植物相比，EnChEVAR 和两种泰尔茂主动脉开窗支架移植物的主动脉颈可行性显著更高。在 71%的病例中，使用任何三种当前可用的低轮廓（Zenith Fenestrated LP、Fenestrated Anaconda LoPro90、Fenestrated Treo）的分支移植物进行治疗都是可行的。
大多数接受 ChEVAR 治疗的患者都不能接受第一代开窗支架移植物治疗。当前可用的开窗腔内移植物，具有更低的轮廓，也适用于倾斜的颈部，增加了解剖学可行性。
