Szopiński Piotr, Pleban Eliza, Iwanowski Jarosław
Clinic of Vascular Surgery, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland.
Rev Cardiovasc Med. 2022 Jun 24;23(7):239. doi: 10.31083/j.rcm2307239. eCollection 2022 Jul.
To report results of application a new stent graft design for the treatment of patients with thoraco-abdominal aneurysms (TAAAs), which was co-invented by a vascular surgeon. This is a retrospective observational study.
The Colt is a self-expanding stent graft, composed of nitinol metal stents creating a special exoskeleton with asymmetric springs covered with polyester material. The Colt device offers some advantages over existing stent graft options. The main body is available in two different diameters on both ends and in three different lengths. It has four branches pointing downward and coming from the main stent graft at two levels. It offers the physician an opportunity to decide which branch to choose for the target vessel. It may be implanted alone or extended proximally and distally. Balloon expandable and/or self-expanding stent grafts are used to create the visceral branches. In complex extensive aneurysms, the procedure is divided into two or three stages to minimize the risks of spinal cord ischemia.
Between August 2015 and December 2021, twenty-two Colt stent grafts were implanted in twenty males and two females (aged 56-81) with TAAAs (eight Type II; twelve Type III; two Type IV). The mean aneurysm diameter was 73.4 mm (range 64-83). All patients were asymptomatic. Eighty-five target vessels were reconstructed using either self-expanding or balloon-expandable stent grafts. Fourteen bifurcated, six custom-made tubes and two aortouniiliac (AUI) stent grafts were used as distal extensions to the Colt device. Completion angiography revealed no type I endoleaks. Five patients had Type II endoleaks which were treated conservatively. There were no intraoperative deaths. One patient died on the 7th postoperative day from multiorgan failure. We did not observe any other complications within 30 days after implantation. One patient died from Covid-19 two months after discharge. Follow-up ranged from three to 75 months. There was no migration or dislocation of the docking station or proximal and distal extensions. All Colt device prostheses remained patent, however, two branches leading to the coeliac trunk were found occluded at the time of the 12-month CTA, without any symptoms. In two patients, there were late problems with three renal bridging stent grafts. One of the Type II endoleaks resolved spontaneously after one year, while four others remain under observation. No patient had an increase in sac diameter.
Results from the current series are promising. The Colt stent graft can be applied to a large variety of TAAA anatomies, which may facilitate the development of new "off-the-shelf" devices in the future.
报告一种由血管外科医生共同发明的新型支架移植物设计用于治疗胸腹主动脉瘤（TAAA）患者的应用结果。这是一项回顾性观察研究。
Colt是一种自膨胀式支架移植物，由镍钛诺金属支架组成，形成一种特殊的外骨骼结构，带有不对称弹簧并覆盖聚酯材料。Colt装置相对于现有的支架移植物选项具有一些优势。主体两端有两种不同直径，有三种不同长度。它有四个分支向下，从主支架移植物的两个层面发出。这为医生提供了选择哪个分支用于目标血管的机会。它可以单独植入，也可以向近端和远端延伸。球囊可扩张和/或自膨胀式支架移植物用于创建内脏分支。在复杂的广泛性动脉瘤中，手术分为两个或三个阶段以尽量减少脊髓缺血的风险。
2015年8月至2021年12月期间，22个Colt支架移植物被植入20名男性和2名女性（年龄56 - 81岁）的TAAA患者体内（8例II型；1例III型；2例IV型）。动脉瘤平均直径为73.4毫米（范围64 - 83）。所有患者均无症状。使用自膨胀或球囊可扩张支架移植物重建了85条目标血管。14个分叉型、6个定制管和2个主动脉单髂（AUI）支架移植物用作Colt装置的远端延伸。完成血管造影显示无I型内漏。5例患者有II型内漏，采用保守治疗。无术中死亡。1例患者术后第7天死于多器官功能衰竭。植入后30天内未观察到任何其他并发症。1例患者出院后两个月死于新冠病毒。随访时间为3至75个月。对接站或近端和远端延伸无移位或脱位。所有Colt装置假体均保持通畅，但在12个月CTA时发现通往腹腔干的两个分支闭塞，无任何症状。2例患者的3个肾桥接支架移植物出现晚期问题。1例II型内漏在1年后自发消失，另外4例仍在观察中。无患者瘤腔直径增加。
本系列结果很有前景。Colt支架移植物可应用于多种TAAA解剖结构，这可能有助于未来新型“现成”装置的开发。
