Dorenberg Eric, Schrøder-Aasen Anne-Marte, Lindberg Beate, Andersen Rune, Guvåg Steinar, Carling Ulrik
Department of Radiology, Section of Interventional Radiology, Oslo University Hospital, Oslo, Norway.
Faculty of Medicine, University of Oslo, Oslo, Norway.
CVIR Endovasc. 2025 Aug 7;8(1):63. doi: 10.1186/s42155-025-00579-2.
The aim of this study was to compare the use of combined fenestrated and bifurcated aortic endografts to the standard modular design including a proximal fenestrated and a distal, bifurcated endograft. The combined design allows for a modification of the procedure that may contribute to lowering the risk of damaging the target vessel stents and reducing the perioperative obstruction of the ipsilateral access vessel.
Consecutive patients treated with fenestrated aortic repair between December 2020 and December 2022 were included in this retrospective, single center study. Technical success was analyzed, including the integrity of the target vessel (TV) stents assessed on perioperative CT. Further, the duration during which the large introducer had to be kept in the access vessel was analyzed. Finally, we report technical data on the endograft design, adverse events and midterm results.
Twelve patients were treated with a modular endograft (group A) and 13 patients with a combined endograft design (group B). Technical success was 100% in both groups, however there were 4 deformed target vessel stents in group A, none in group B. The duration of potential flow reduction due to a large introducer in the access vessel was significantly shorter in group B than group A (median 54 min vs. 109.5 min, p < 0.05). No adverse events were reported in any of the groups. The observation period was shorter in group B (median 18 months vs. 33 months, p < 0.05). Except for one case of aneurysm growth in group A, all other patients in both groups showed stable or decreased aneurysm size without TV occlusions.
The integration of the bifurcation on the fenestrated endograft may contribute to the prevention of damage of the TV stents and has potential to reduce the duration of perioperative limb obstruction.
本研究的目的是比较联合开窗和分叉型主动脉内移植物与标准模块化设计（包括近端开窗和远端分叉内移植物）的使用情况。联合设计允许对手术进行改进，这可能有助于降低损伤目标血管支架的风险，并减少同侧入路血管的围手术期阻塞。
本回顾性单中心研究纳入了2020年12月至2022年12月期间接受开窗主动脉修复术的连续患者。分析技术成功率，包括在围手术期CT上评估的目标血管（TV）支架的完整性。此外，分析了大型导入器必须保留在入路血管中的持续时间。最后，我们报告了内移植物设计的技术数据、不良事件和中期结果。
12例患者接受模块化内移植物治疗（A组），13例患者接受联合内移植物设计治疗（B组）。两组的技术成功率均为100%，然而A组有4个目标血管支架变形，B组无。B组因大型导入器导致入路血管潜在血流减少的持续时间明显短于A组（中位数54分钟对109.5分钟，p<0.05）。两组均未报告不良事件。B组的观察期较短（中位数18个月对33个月，p<0.05）。除A组有1例动脉瘤增大外，两组的所有其他患者均显示动脉瘤大小稳定或减小，无TV闭塞。
开窗内移植物上的分叉整合可能有助于预防TV支架的损伤，并有可能减少围手术期肢体阻塞的持续时间。
