Nardi Priscilla, Rinaldi Valerio, Costanzo Maria Ludovica, Pasqua Rocco, Loiacono Francesco, Palumbo Piergaspare, Miraldi Fabio, Tanzilli Gaetano, D'Andrea Vito, Illuminati Giulio
Department of Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy.
Department of Cardiac Surgery, Sapienza University of Rome, Viale Regina Elena, 324, 00161 Rome, Italy.
J Clin Med. 2024 Sep 19;13(18):5545. doi: 10.3390/jcm13185545.
: Performing percutaneous coronary intervention (PCI) and endovascular aneurysm repair (EVAR) at the same time represents a groundbreaking development in the multidisciplinary treatment of cardiovascular disease. This combined PCI-EVAR approach bridges a critical gap by offering treatment for patients who have both coronary artery disease and aortic aneurysms. This innovative strategy exemplifies the evolving landscape of cardiovascular care, providing a new solution for complex clinical situations that previously required separate procedures. : Six patients with critical coronary artery lesions and asymptomatic infrarenal aortic aneurysms (AAAs) ≥ 6 cm diameter, as well as one patient with critical coronary artery lesions and endoleak type 1A with aneurysms ≥ 6 cm, underwent simultaneous coronary artery revascularization through percutaneous intervention (PCI) and endovascular aneurysm repair (EVAR). The occurrence of any intraoperative or postoperative complication was considered to be the primary endpoint of the study, including the abortion or failure of either PCI or EVAR, bleeding requiring a conversion to open surgical procedures, the failure of local anesthesia, postoperative myocardial or lower limb ischemia, and a postoperative serum creatinine level of >125 mmol/L or of >180 mmol/L in patients affected by chronic renal failure. The overall length of the procedure, X-ray exposure, the quantity of iodine contrast medium administered, and the length of recovery were considered to be secondary endpoints. : Postoperative complications included two episodes of acute renal failure in the two patients already affected by chronic renal failure, which were easily resolved with adequate daily hydration and the elimination of nephrotoxic drugs. In no cases did cardiac ischemia or lower limb ischemia occur. The average procedure duration was 198 min (range: 180-240 min), the average fluoroscopy duration was 41.7 min (range: 35-50 min), the average amount of iodinated contrast medium was 34.8 mL (range: 30-40 mL), and the mean length of hospitalization was 2.7 days (range: 2-5 days). : In selected patients, this surgical approach has demonstrated safety, reduced hospitalization times, minimized risks associated with complications from the untreated condition if procedures were performed at different times, and facilitated the effective management of intraoperative complications due to the presence of a multidisciplinary team. However, the limited number of patients necessitates further research.
同时进行经皮冠状动脉介入治疗（PCI）和血管内动脉瘤修复术（EVAR）是心血管疾病多学科治疗中的一项开创性进展。这种PCI-EVAR联合方法为患有冠状动脉疾病和主动脉瘤的患者提供了治疗，填补了一个关键空白。这一创新策略体现了心血管护理不断演变的格局，为以前需要单独进行手术的复杂临床情况提供了新的解决方案。
六名患有严重冠状动脉病变且无症状的肾下腹主动脉瘤（AAA）直径≥6 cm的患者，以及一名患有严重冠状动脉病变且动脉瘤≥6 cm并伴有1A型内漏的患者，通过经皮介入（PCI）和血管内动脉瘤修复术（EVAR）同时进行了冠状动脉血运重建。任何术中或术后并发症的发生被视为该研究的主要终点，包括PCI或EVAR的中止或失败、需要转为开放手术的出血、局部麻醉失败、术后心肌或下肢缺血，以及慢性肾衰竭患者术后血清肌酐水平>125 mmol/L或>180 mmol/L。手术的总时长、X射线暴露时间、碘造影剂的使用量以及恢复时长被视为次要终点。
术后并发症包括两名已患有慢性肾衰竭的患者出现两例急性肾衰竭，通过充足的每日补液和停用肾毒性药物后很容易得到解决。未发生心脏缺血或下肢缺血的情况。平均手术时长为198分钟（范围：180 - 240分钟），平均透视时长为41.7分钟（范围：35 - 50分钟），平均碘化造影剂使用量为34.8毫升（范围：30 - 40毫升），平均住院时长为2.7天（范围：2 - 5天）。
在选定患者中，这种手术方法已证明具有安全性，缩短了住院时间，将因不同时间进行手术而未治疗的病情引发并发症的风险降至最低，并且由于多学科团队的存在便于有效处理术中并发症。然而，患者数量有限，需要进一步研究。
