Mulorz Joscha, Costanza Laura M, Vockel Malwina, Mazrekaj Agnesa, Arnautovic Amir, Garabet Waseem, Oberhuber Alexander, Schelzig Hubert, Wagenhäuser Markus U
Clinic for Vascular and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
Department of Vascular and Endovascular Surgery, University Hospital Münster, Münster, Germany.
J Surg Res. 2025 Jan;305:171-182. doi: 10.1016/j.jss.2024.11.018. Epub 2024 Dec 18.
Despite the widespread use of branched (bEVAR) and fenestrated endovascular aortic repair (fEVAR) for complex aortic pathologies, there are no reliable recommendations regarding postsurgery antiplatelet therapy. We therefore evaluated the outcome of single (SAPT) and dual antiplatelet therapy (DAPT) following fEVAR and bEVAR.
A total of 63 patients from two German centers treated for complex aortic pathologies were included in this retrospective study. Patient data and computed tomography angiograms were analyzed. Kaplan-Meier analyses for overall survival and freedom from target vessel (TV)-related complications were performed. The outcomes were compared between SAPT versus DAPT and bEVAR versus fEVAR. Univariate logistic regression was applied to analyze the correlation between TV patency and various anatomical aortic parameters.
In total, 30 patients were treated with fEVAR and 33 with bEVAR. Of these, 19 patients received SAPT and 44 received DAPT postsurgery. Anatomical aortic characteristics and comorbidities were comparable among groups. Overall survival was 95% (±5.1) for SAPT and 88% (±8.8) for DAPT after 36 mo of follow-up. Patency was evaluated individually for each TV SAPT versus DAPT (celiac trunk 100% ± 0 versus 87% ± 9.6; superior mesenteric artery 86% ± 13.2 versus 100% ± 0; left renal artery 92% ± 8.0 versus 95% ± 3.6; right renal artery 72% ± 15.2 versus 81% ± 9.9). Freedom from endoleak was 35% (±13.7) for SAPT versus 30% (±13.8) for DAPT. There was no statistically significant difference for SAPT versus DAPT or for bEVAR versus fEVAR. Further, none of the anatomical aortic characteristics and bridging stent graft-related parameters analyzed predicted TV occlusion in logistic regression analysis.
We did not observe differences in overall survival, endoleak, and TV patency rates between SAPT and DAPT treated patients following bEVAR and/or fEVAR. Patient-specific factors therefore appear to be more relevant for the long-term outcomes rather than the antiplatelet regime applied postsurgery.
尽管分支型（bEVAR）和开窗型血管内主动脉修复术（fEVAR）广泛用于治疗复杂主动脉病变，但术后抗血小板治疗尚无可靠的推荐方案。因此，我们评估了fEVAR和bEVAR术后单药抗血小板治疗（SAPT）和双联抗血小板治疗（DAPT）的效果。
这项回顾性研究纳入了来自德国两个中心的63例接受复杂主动脉病变治疗的患者。分析了患者数据和计算机断层扫描血管造影。进行了总体生存率和无靶血管（TV）相关并发症的Kaplan-Meier分析。比较了SAPT与DAPT以及bEVAR与fEVAR的结果。应用单因素逻辑回归分析TV通畅与各种主动脉解剖参数之间的相关性。
总共30例患者接受了fEVAR治疗，33例接受了bEVAR治疗。其中，19例患者术后接受了SAPT，44例接受了DAPT。各组间主动脉解剖特征和合并症具有可比性。随访36个月后，SAPT组的总生存率为95%（±5.1），DAPT组为88%（±8.8）。分别评估了每个TV的SAPT与DAPT通畅情况（腹腔干100%±0对87%±9.6；肠系膜上动脉86%±13.2对100%±0；左肾动脉92%±8.0对95%±3.6；右肾动脉72%±15.2对81%±9.9）。SAPT组无内漏发生率为35%（±13.7），DAPT组为30%（±13.8）。SAPT与DAPT之间或bEVAR与fEVAR之间无统计学显著差异。此外，在逻辑回归分析中，所分析的主动脉解剖特征和桥接支架移植物相关参数均未预测TV闭塞。
我们未观察到bEVAR和/或fEVAR术后接受SAPT和DAPT治疗的患者在总生存率、内漏和TV通畅率方面存在差异。因此，患者个体因素似乎比术后应用的抗血小板方案对长期预后更具相关性。
