Vascular Centre, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
Vascular Centre, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
Eur J Vasc Endovasc Surg. 2024 Nov;68(5):560-566. doi: 10.1016/j.ejvs.2024.06.007. Epub 2024 Jun 12.
To compare and evaluate early and midterm outcomes of a novel no cross approach with short tip vs. standard tip introducer systems for all distal components to prevent target vessel bridging stent kink or collapse during fenestrated endovascular aortic repair (FEVAR).
A retrospective analysis was conducted on all patients who underwent FEVAR at a tertiary referral centre between October 2016 and July 2022. The inclusion criterion was the use of renal artery fenestrations. Patients who had chronic dissections were included. Endpoints were analysed in two groups comprising the no cross group and the standard group, with all cases being consecutive in their respective groups. Cone beam computed tomography was used intra-operatively in all cases, and post-operative computed tomography angiograms and re-interventions were reviewed. Primary endpoints included technical success, intra-operative adjunctive procedures, adverse events related to the fenestration, and re-interventions, while secondary endpoints were secondary interventions and overall mortality rate.
Seventy patients (35 in each group) were enrolled in the study, with 64 (91%) having juxtarenal aneurysms. There were no differences in demographics, cardiovascular risk factors, or aneurysm characteristics between the two groups. The no cross group demonstrated a significantly higher technical success rate (100% in all cases) compared with the standard group (29 cases, 83%; p = .010). Additionally, there were statistically significantly fewer intra-operative adjunctive procedures required in the no cross group (1.5% of fenestrations) compared with the standard group (8.2% of fenestrations) (p = .013). The overall median follow up was 32 months (interquartile range 22, 62 months).
Implementation of a novel no cross concept during FEVAR, using a short dilator introducer tip on the distal bifurcated component and iliac extensions, significantly reduced intra-operative fenestration related adverse events and enhanced technical success. Further studies with larger patient populations and longer follow up are needed to confirm these findings.
比较并评估新型无交叉短尖端与标准尖端导入器系统在所有远端分叉组件中的早期和中期结果，以防止在腔内血管修复（fenestrated endovascular aortic repair，FEVAR）中目标血管桥接支架扭结或塌陷。
对 2016 年 10 月至 2022 年 7 月在三级转诊中心接受 FEVAR 的所有患者进行回顾性分析。纳入标准为使用肾动脉开窗。包括慢性夹层患者。分析两组的终点，分别为无交叉组和标准组，两组均为连续病例。所有病例均在术中使用锥形束计算机断层扫描（cone beam computed tomography，CBCT），并对术后计算机断层血管造影（computed tomography angiography，CTA）和再干预进行复查。主要终点包括技术成功率、术中辅助操作、与开窗相关的不良事件和再干预，次要终点包括二次干预和总体死亡率。
研究共纳入 70 例患者（每组 35 例），64 例（91%）为肾周动脉瘤。两组患者的人口统计学、心血管危险因素或动脉瘤特征无差异。无交叉组的技术成功率（100%）明显高于标准组（29 例，83%；p =.010）。此外，无交叉组术中需要的辅助操作明显减少（1.5%的开窗），而标准组需要的辅助操作（8.2%的开窗）更多（p =.013）。中位总体随访时间为 32 个月（22 至 62 个月）。
在 FEVAR 中实施新型无交叉概念，使用远端分叉组件和髂内延伸的短扩张器尖端，显著减少了术中与开窗相关的不良事件，并提高了技术成功率。需要进一步进行具有更大患者人群和更长随访时间的研究来证实这些发现。
