Piwowarczyk Marek, Rubinkiewicz Mateusz, Krzywoń Jerzy, Kołodziejski Marcin, Krzyżewski Roger M, Zbierska-Rubinkiewicz Katarzyna
Department of Vascular Surgery, University Hospital, Jagiellonian University, Krakow, Poland.
2 Department of General Surgery, Jagiellonian University, Krakow, Poland.
Wideochir Inne Tech Maloinwazyjne. 2024 Mar;19(1):100-106. doi: 10.5114/wiitm.2024.136248. Epub 2024 Mar 11.
Endovascular aortic repair (EVAR) is nowadays a widespread method of managing abdominal aortic aneurysm (AAA). Low-profile stent grafts (LPSGs) enable treatment of patients with complex and anatomically challenging aneurysms, and facilitate a percutaneous and thus less invasive procedure.
To assess the outcomes of EVAR with low-profile versus standard-profile stent grafts (SPSGs).
Thirty-one patients with abdominal aortic aneurysms (AAA) were treated by endovascular aortic repair (EVAR) using LPSGs. The control group of patients treated with SPSGs was matched with MedCalc software. The clinical records and the preoperative and follow-up computed tomography angiography of patients who underwent endovascular treatment of AAA were included in this study.
Patients in the LPSG group had significantly more often low access vessel diameter (< 6 mm) compared to the SPSG group (38.7% vs. 6.7%, p = 0.003). In 1-year follow-up, there was no rupture, no infection, no conversion to open repair and no aneurysm-related death. Five secondary interventions were necessary in the SPSG group and only 1 in the LPSG group (p = 0.09). Type of stent graft was not a risk factor of perioperative complications, presence of endoleak or reintervention (p > 0.05). Risk factors for perioperative complications were COPD and conical neck (OR = 6.3, 95% CI: 1.5-25, p = 0.01 and OR = 6.2, 95% CI: 1-39.76, p = 0.04). The risk factor for endoleak was lower maximal aneurysm diameter. The risk factor for reintervention was proximal neck diameter (OR = 0.77, 95% CI: 0.-0.97, p = 0.03).
Our study showed that use of LPSGs is a safe and viable method for patients with narrow access vessels who are not eligible for standard-profile systems.
血管腔内主动脉修复术（EVAR）如今是治疗腹主动脉瘤（AAA）的一种广泛应用的方法。低轮廓支架移植物（LPSG）能够治疗患有复杂且解剖结构具有挑战性的动脉瘤的患者，并有助于采用经皮穿刺方式，从而使手术创伤更小。
评估使用低轮廓支架移植物与标准轮廓支架移植物（SPSG）进行EVAR的疗效。
31例腹主动脉瘤（AAA）患者采用低轮廓支架移植物（LPSG）进行血管腔内主动脉修复术（EVAR）治疗。使用MedCalc软件对接受标准轮廓支架移植物（SPSG）治疗的患者作为对照组进行匹配。本研究纳入了接受腹主动脉瘤血管腔内治疗患者的临床记录以及术前和随访计算机断层扫描血管造影。
与标准轮廓支架移植物（SPSG）组相比，低轮廓支架移植物（LPSG）组患者的入路血管直径较小（<6mm）的情况更为常见（38.7%对6.7%，p = 0.003）。在1年的随访中，未发生破裂、感染、转为开放修复以及与动脉瘤相关的死亡。标准轮廓支架移植物（SPSG）组需要进行5次二次干预，而低轮廓支架移植物（LPSG）组仅需1次（p = 0.09）。支架移植物类型不是围手术期并发症、内漏或再次干预的危险因素（p>0.05）。围手术期并发症的危险因素是慢性阻塞性肺疾病（COPD）和锥形颈部（OR = 6.3，95%CI：1.5 - 25；p = 0.01）以及OR = 6.2，95%CI：1 - 39.76，p = 0.04）。内漏的危险因素是最大动脉瘤直径较小。再次干预的危险因素是近端颈部直径（OR = 0.77，95%CI：0. - 0.97，p = 0.03）。
我们的研究表明，对于不符合标准轮廓系统条件的入路血管狭窄患者，使用低轮廓支架移植物（LPSG）是一种安全可行的方法。
