Department of Cardiovascular Surgery, Sapporo Medical University, Sapporo, Japan.
Department of Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, Japan.
Eur J Cardiothorac Surg. 2024 Nov 4;66(5). doi: 10.1093/ejcts/ezae404.
In this multicentre retrospective observational study, we present the early outcomes of physician-modified fenestrated/inner-branched endovascular repair for pararenal and thoracoabdominal aortic aneurysms in patients at high risk for open surgical repair.
We comprehensively reviewed the clinical data and outcomes of consecutive patients treated with physician-modified fenestrated/inner-branched endovascular repair for pararenal or thoracoabdominal aortic aneurysms at 6 centres between December 2020 and December 2021. Primary end-points included technical success, in-hospital mortality rates, major adverse events.
Seven and 31 patients (median age, 80.5 years) had pararenal and thoracoabdominal aortic aneurysms, respectively, involving 93 renal-mesenteric arteries incorporated through 10 fenestrations or 83 inner branches. Seven patients (18.4%) were treated non-elective conditions. The technical success rate was 89.5%. The median operative time was 334.5 min. Ten patients (26.3%) experienced major adverse events, including in-hospital mortality in 6 patients (15.8%), acute kidney injury in 3 patients (7.9%), respiratory failure in 3 patients (7.9%), bowel ischaemia in 1 patient (2.6%), stroke in 1 patient (2.6%) and paraplegia in 1 patient (2.6%). Among elective cases, in-hospital deaths occurred in 3 patients (9.7%), while in non-elective cases, the mortality rate was higher, with 3 patients (42.9%) succumbing. The median follow-up duration was 14 months.
Physician-modified fenestrated/inner-branched endovascular repair is a viable treatment for pararenal or thoracoabdominal aortic aneurysms in patients at high risk for open surgical repair. It provides customization without location constraints or production delays, but further validation is needed to ensure long-term reliability.
在这项多中心回顾性观察研究中，我们报告了在高危开放手术修复的患者中，医生改良的腔内分支型覆膜支架治疗肾周和胸腹主动脉瘤的早期结果。
我们全面回顾了 2020 年 12 月至 2021 年 12 月 6 家中心连续接受医生改良的腔内分支型覆膜支架治疗肾周或胸腹主动脉瘤的患者的临床数据和结果。主要终点包括技术成功率、院内死亡率、主要不良事件。
7 例患者患有肾周主动脉瘤（中位年龄 80.5 岁），31 例患者患有胸腹主动脉瘤（中位年龄 80.5 岁），涉及 93 个肾-肠系膜动脉，通过 10 个开窗或 83 个分支进行覆盖。7 例（18.4%）患者为非择期治疗。技术成功率为 89.5%。中位手术时间为 334.5 分钟。10 例（26.3%）患者发生主要不良事件，包括 6 例（15.8%）院内死亡、3 例（7.9%）急性肾损伤、3 例（7.9%）呼吸衰竭、1 例（2.6%）肠缺血、1 例（2.6%）中风和 1 例（2.6%）截瘫。在择期手术中，3 例（9.7%）患者院内死亡，而非择期手术中，死亡率较高，有 3 例（42.9%）患者死亡。中位随访时间为 14 个月。
在高危开放手术修复的患者中，医生改良的腔内分支型覆膜支架治疗肾周或胸腹主动脉瘤是一种可行的治疗方法。它提供了定制化的治疗方案，不受位置限制或生产延迟的影响，但需要进一步验证以确保长期的可靠性。
