Spath Paolo, Campana Federica, Gallitto Enrico, Mascoli Chiara, Caputo Stefania, Pini Rodolfo, Faggioli Gianluca, Gargiulo Mauro
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
EJVES Vasc Forum. 2024 Nov 13;63:1-10. doi: 10.1016/j.ejvsvf.2024.11.001. eCollection 2025.
Paravisceral aortic lesions present significant challenges for endovascular treatment. This retrospective analysis of consecutively treated patients from April 2017 to June 2021 aimed to analyse the outcome of primary intra-operative embolisation of aortic complicated pseudoaneurysms and gutter channels during parallel graft (PG) repair of paravisceral symptomatic aortic pseudoaneurysms.
Patients with symptomatic pseudoaneurysms of the paravisceral aorta treated with PGs using chimney or periscope configurations were included. Thoracic endografts were positioned to exclude the aortic lesions. Coil embolisation of both the lesions and gutter channels was performed after graft deployment and prior to ballooning of the stent grafts. The primary endpoints were technical success (defined as exclusion of the pseudoaneurysm, target visceral vessel [TVV] patency, absence of gutter endoleaks) and clinical success (technical success + resolution of symptoms + absence of major adverse events) at 30 days. Secondary endpoints included overall survival, TVV patency, gutter endoleaks, and freedom from re-interventions during follow up.
Six patients (four women) were treated for pseudoaneurysm rupture (three cases) and symptomatic aortic pseudoaneurysm (three cases) of the paravisceral aorta. The patients' anatomies were unsuitable for off the shelf devices and patients were all deemed to be at prohibitive surgical risk. A total of 15 TVVs were revascularised (comprising three coeliac arteries, five superior mesenteric arteries, and seven renal arteries) using 10 chimney and five periscope PGs. One coeliac artery was occluded. Seventy coils were deployed to embolise both the aortic ruptures and gutter channels. Both technical and clinical success rates were 100%. The median follow up was 17 months (IQR 5, 35), during which time three patients died due to non-aortic related causes. One coeliac artery (6%) was occluded, and no endoleak evidence was found.
Primary intra-operative embolisation during parallel graft endovascular repair of paravisceral symptomatic aortic pseudoaneurysms may be both safe and effective in excluding the pseudoaneurysm when other options are unavailable.
内脏旁主动脉病变给血管内治疗带来了重大挑战。本研究对2017年4月至2021年6月连续治疗的患者进行回顾性分析，旨在分析内脏旁有症状主动脉假性动脉瘤平行移植物（PG）修复术中主动脉复杂性假性动脉瘤和沟道的一期术中栓塞效果。
纳入采用烟囱或潜望镜构型的PG治疗内脏旁主动脉有症状假性动脉瘤的患者。放置胸段腔内移植物以排除主动脉病变。在移植物展开后且支架移植物球囊扩张前，对病变和沟道进行弹簧圈栓塞。主要终点为30天时的技术成功（定义为假性动脉瘤排除、靶内脏血管[TVV]通畅、无沟道内漏）和临床成功（技术成功+症状缓解+无重大不良事件）。次要终点包括总生存率、TVV通畅情况、沟道内漏以及随访期间无需再次干预。
6例患者（4例女性）接受了内脏旁主动脉假性动脉瘤破裂（3例）和有症状主动脉假性动脉瘤（3例）的治疗。患者的解剖结构不适合现成的器械，且所有患者均被认为手术风险极高。使用10个烟囱式和5个潜望镜式PG共重建了1个5条肠系膜上动脉和7条肾动脉）。1支腹腔干动脉闭塞。共部署了70个弹簧圈以栓塞主动脉破裂处和沟道。技术成功率和临床成功率均为100%。中位随访时间为17个月（四分位间距5, 35），在此期间，3例患者因非主动脉相关原因死亡。1支腹腔干动脉（6%）闭塞，未发现内漏证据。
在内脏旁有症状主动脉假性动脉瘤的平行移植物血管内修复术中，当没有其他选择时，一期术中栓塞可能在排除假性动脉瘤方面既安全又有效。
