George Justin M, Hatzis Christopher M, Choinski Krystina N, Tadros Rami O, Faries Peter L, Marin Michael L
Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Rev Cardiovasc Med. 2023 Feb 24;24(3):70. doi: 10.31083/j.rcm2403070. eCollection 2023 Mar.
There have been significant technologic advances in endovascular aortic therapies since the introduction of conventional infrarenal endovascular aortic aneurysm repair (EVAR). These advances have sought to address the weaknesses of conventional EVAR- particularly the difficult or "hostile" infrarenal aortic aneurysm neck. We review anatomical features that create a hostile neck and the most recent advancements to overcome these limitations. EndoAnchors replicate open suture fixation to seal endograft to aortic tissue and have been shown to be useful as a prophylactic measure in short, angulated necks as well as therapeutic for type Ia endoleaks. Fenestrated EVAR (FEVAR) devices such as the Z-fen (Cook Medical, Bloomington, IN, USA) raises the seal zone to the suprarenal segment while maintaining renal perfusion. Finally, multibranch aortic grafts such as the Thoracoabdominal Branch Endoprosthesis (Tambe; W. L. Gore & Associates, Flagstaff, AZ, USA) raise the seal zone above the visceral segment and can be used off the shelf with promising results.
自从传统的肾下腔内腹主动脉瘤修复术（EVAR）问世以来，血管内主动脉治疗技术取得了重大进展。这些进展旨在解决传统EVAR的弱点，尤其是困难或“恶劣”的肾下主动脉瘤颈部问题。我们回顾了造成恶劣颈部的解剖学特征以及克服这些局限性的最新进展。EndoAnchors复制了开放缝合固定术，将血管内移植物密封到主动脉组织上，已被证明在短的、成角的颈部作为一种预防措施是有用的，并且对Ia型内漏有治疗作用。带开窗的EVAR（FEVAR）装置，如Z-fen（美国印第安纳州布卢明顿市库克医疗公司），在维持肾灌注的同时，将密封区提升到肾上腺段。最后，多分支主动脉移植物，如胸腹分支内支架（Tambe；美国亚利桑那州弗拉格斯塔夫市W.L.戈尔公司），将密封区提升到内脏段上方，并且可以现货供应，效果良好。
