Pastor Alconchel Laura, Inaraja Pérez Gabriel Cristian, Herrando Medrano Mónica, García Nieto Beatriz, Hidalgo Iranzo Noemí, Marzo Álvarez Ana Cristina
Angiology and Vascular Surgery Service, Miguel Servet Hospital, Zaragoza, Spain.
Angiology and Vascular Surgery Service, Lozano Blesa Clinical Hospital, Zaragoza, Spain; Grupo de Investigación en patología vascular GISSA019, Instituto de Investigación Sanitaria Aragón, Zaragoza, Aragón, Spain.
Ann Vasc Surg. 2024 Dec;109:414-423. doi: 10.1016/j.avsg.2024.07.092. Epub 2024 Aug 2.
We analyzed the long-term influence of fixation systems on proximal aortic neck (PAN) evolution by comparing 2 late-generation endoprostheses, Endurant (Medtronic Vascular, Minneapolis, Minn) with suprarenal fixation (SRF) and Excluder (W.L Gore & Associates, Flagstaff, Ariz) with infrarenal fixation (IRF).
Our retrospective observational study included consecutive patients undergoing endovascular aneurysm repair (EVAR) for aorto-iliac aneurysms (2011-2020). Primary end points: neck enlargement and freedom from significative PAN enlargement (5 mm). Secondary end points: neck-related reintervention, endoleaks and graft migration. Results were reported following the Society of Vascular Surgery reporting standards.
139 patients were included (97 in SRF group and 42 in IRF group). A difference in growth at 10 mm caudal to lowest renal artery at 2 years follow-up was found (mean growth of 1.92 ± 3.38 mm in SRF and 0.16 ± 6.86 mm in IRF; P < 0.001). A tendency to a major growth in SRF at 4 years follow-up at the lowest renal artery (1.27 ± 3.36 mm vs. 0.63 ± 2.2 mm; P = 0.06), 5 mm distal to lowest renal artery (2.17 ± 3.52 mm vs. 0.94 ± 2.76 mm; P = 0.001) and 10 mm distal to lowest renal artery (2.65 ± 3.86 mm vs. 1.12 ± 1.5 mm; P < 0.001) was shown. Freedom from PAN enlargement was 96.65% and 88.20% in SRF and 100% and 94.4% in IRF at 2 and 4 years follow-up respectively (log rank 0.041). A greater incidence of type II endoleaks in IRF was observed (40.48% vs. 15.46%; P = 0.001). Oversizing >15% showed to be a risk factor of PAN enlargement (odds ratio 6.85; 95% confident interval: 1.67-28.4; P = 0.007).
A small but significative percentage of patients after EVAR show a progressive PAN enlargement, being significatively greater in SRF, without increasing neck-related complications 4 years after graft deployment.
我们通过比较两种新一代血管内修复装置，即采用肾上固定（SRF）的美敦力血管公司（位于明尼苏达州明尼阿波利斯）的Endurant和采用肾下固定（IRF）的WL戈尔公司（位于亚利桑那州弗拉格斯塔夫）的Excluder，分析了固定系统对近端主动脉颈部（PAN）演变的长期影响。
我们的回顾性观察研究纳入了2011年至2020年连续接受腹主动脉瘤腔内修复术（EVAR）治疗主-髂动脉瘤的患者。主要终点：颈部增粗以及无显著的PAN增粗（5毫米）。次要终点：与颈部相关的再次干预、内漏和移植物移位。结果按照血管外科学会的报告标准进行报告。
共纳入139例患者（SRF组97例，IRF组42例）。在随访2年时，发现最低肾动脉下方10毫米处的生长存在差异（SRF组平均生长1.92±3.38毫米，IRF组为0.16±6.86毫米；P<0.001）。在随访4年时，最低肾动脉处（1.27±3.36毫米对0.63±2.2毫米；P=0.06）、最低肾动脉下方5毫米处（2.17±3.52毫米对0.94±2.76毫米；P=0.001）以及最低肾动脉下方10毫米处（2.65±3.86毫米对1.12±1.5毫米；P<0.001），SRF组均显示出更大的生长趋势。在随访2年和4年时，SRF组无PAN增粗的比例分别为96.65%和88.20%，IRF组分别为100%和94.4%（对数秩检验P=0.041）。观察到IRF组II型内漏的发生率更高（40.48%对15.46%；P=0.001）。直径过大>15%被证明是PAN增粗的一个危险因素（比值比6.85；95%置信区间：1.67-28.4；P=
