Moothathamby Thurkga, Jubouri Matti, Rajasekar Tharun, Roy Subham, Alfwaress Maya, Rezk Samuel S S, Ghattas Samuel N S, D'Oria Mario, Bailey Damian M, Williams Ian M, Bashir Mohamad
Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Hull York Medical School, University of York, York, UK.
Exp Physiol. 2025 Mar;110(3):370-381. doi: 10.1113/EP091813. Epub 2025 Jan 27.
Fenestrated/branched endovascular aortic repair emerges as the primary therapeutic modality for intricate aortic pathologies encompassing the paravisceral and thoracoabdominal segments, where bridging stent grafts (BSGs) play a vital role in linking the primary aortic endograft with target vessels. Bridging stent grafts can be categorized mainly into self-expanding stent grafts (SESGs) and balloon-expandable stent grafts (BESGs). Physiological factors significantly influence post-complex endovascular aortic repair BSG behaviour, impacting clinical outcomes of SESGs and BESGs in different but overlapping ways. Crucial prerequisites for BSGs encompass not only flexibility but also resilience against mechanical stress and compliance mismatch, especially when bridging the rigid aortic main body with dynamic target vessels. The significance of considering these physiological factors in clinical decision-making is underscored by recognizing the interplay between SESG and BESG characteristics, vessel physiology and patient haemorheology. Such factors include the anatomy and tortuosity of the vessel, diameter of the vessel and BSG, deployment and durability, extrinsic stenosis and respiratory motion. Haemorheological factors, such as anti-thrombotic therapy and hydration status, need to be considered. This narrative review examines both in vitro and in vivo evidence regarding the impact of physiological factors on the behaviour of BSGs and assesses the consequences for clinical outcomes following complex endovascular aortic repair.
开窗/分支型血管腔内主动脉修复术已成为治疗累及内脏旁和胸腹段复杂主动脉病变的主要治疗方式，其中桥接支架移植物（BSG）在连接主动脉主腔内移植物与靶血管方面发挥着至关重要的作用。桥接支架移植物主要可分为自膨式支架移植物（SESG）和球囊扩张式支架移植物（BESG）。生理因素对复杂血管腔内主动脉修复术后BSG的行为有显著影响，以不同但相互重叠的方式影响SESG和BESG的临床结果。BSG的关键先决条件不仅包括灵活性，还包括抗机械应力和顺应性不匹配的能力，尤其是在连接刚性主动脉主体与动态靶血管时。认识到SESG和BESG特性、血管生理学和患者血液流变学之间的相互作用，凸显了在临床决策中考虑这些生理因素的重要性。这些因素包括血管的解剖结构和迂曲度、血管和BSG的直径、展开和耐久性、外在狭窄和呼吸运动。血液流变学因素，如抗血栓治疗和水化状态，也需要考虑。本叙述性综述研究了生理因素对BSG行为影响的体外和体内证据，并评估了复杂血管腔内主动脉修复术后对临床结果的影响。
