Lawrence-Brown M M, Hartley D, MacSweeney S T, Kelsey P, Ives F J, Holden A, Gordon M, Goodman M A, Sieunarine K
Vascular Surgery Department, Royal Perth Hospital, Western Australia.
Cardiovasc Surg. 1996 Dec;4(6):706-12. doi: 10.1016/s0967-2109(96)00046-4.
The study aim was to develop a reliable endoluminal graft system that would enable the deployment of a bifurcated graft for infrarenal abdominal aortic aneurysms. A life-size plastic model was made of an abdominal aorta and iliac arteries, with a 50-mm infrarenal abdominal aortic aneurysm. This model was used to develop and test self-expanding graft systems, based on a barbed Gianturco stent and series of stainless-steel 'Z' stents within a woven Dacron graft. The bifurcated system developed involves a trouser graft with one long leg and one short. This graft-system is delivered through one femoral artery with deployment of the proximal aortic end infrarenally and the longer trouser leg within the ipsilateral common iliac artery. The short trouser leg is left hanging free within the distal end of the aneurysm cavity, just above the bifurcation. It is held open by a self-expanding stent and is cannulated from the contralateral femoral artery with a guide wire. A simple straight self-expanding stented graft is then deployed to extend this short trouser leg down into the common iliac artery, effectively creating an extension to the short leg. The graft system has been deployed in 21 patients with satisfactory exclusion of the aneurysm in 17 (81%). There has been one mortality and no conversion to open repair. All 17 aneurysms remain excluded at median follow-up of 30 (range 4-60) weeks. None of the four graft stents that leaked (two proximal and two distal) sealed spontaneously. Deployment of the uncovered Gianturco stent across the renal artery origins in 18 cases (85%) has not been associated with renal artery occlusion or deterioration in renal function at a median follow-up of 30 (range 4-60) weeks. The ability to deploy a bifurcated system increases the potential for endoluminal treatment of abdominal aortic aneurysm.
本研究的目的是开发一种可靠的腔内移植物系统，该系统能够用于部署治疗肾下腹主动脉瘤的分叉移植物。制作了一个真人大小的腹主动脉和髂动脉塑料模型，带有一个50毫米的肾下腹主动脉瘤。该模型用于开发和测试基于带倒刺的吉安蒂尔科支架和一系列编织涤纶移植物内的不锈钢“Z”形支架的自膨胀移植物系统。所开发的分叉系统包括一个有一条长腿和一条短腿的裤形移植物。该移植物系统通过一条股动脉输送，将近端主动脉端肾下置入，并将较长的裤腿置入同侧髂总动脉内。短裤腿在动脉瘤腔远端内、刚好在分叉上方自由悬挂。它由一个自膨胀支架撑开，并通过一根导丝从对侧股动脉进行插管。然后部署一个简单的直形自膨胀带支架移植物，将这条短裤腿向下延伸至髂总动脉，有效地形成短腿的延伸。该移植物系统已应用于21例患者，17例（81%）的动脉瘤得到满意隔绝。有1例死亡，无转为开放修复的情况。在中位随访30周（范围4 - 60周）时，所有17个动脉瘤仍保持隔绝状态。4个发生渗漏的移植物支架（2个近端和2个远端）均未自行封闭。18例（85%）在肾动脉起始处部署未覆盖的吉安蒂尔科支架，在中位随访30周（范围4 - 60周）时，未出现肾动脉闭塞或肾功能恶化。部署分叉系统的能力增加了腔内治疗腹主动脉瘤的可能性。
