Changes in Aortoiliac Anatomy After Elective Treatment of Infrarenal Abdominal Aortic Aneurysms with a Sac Anchoring Endoprosthesis
Changes in Aortoiliac Anatomy After Elective Treatment of Infrarenal Abdominal Aortic Aneurysms with a Sac Anchoring Endoprosthesis
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DOI：
10.1016/j.ejvs.2015.08.019
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发表时间：
2016-01-01
影响因子：
5.7
通讯作者：
de Vries, J. P. P. M.
中科院分区：
文献类型：
--
作者：
Boersen, J. T.;Schuurmann, R. C. L.;de Vries, J. P. P. M.
目的：使用Nellixendosystem（Endologix，Irvine，CA，USA）进行血管内主动脉凝闭（EVAS）是治疗肾下腹主动脉瘤（AAA）的新概念。通过密封动脉瘤，可以避免潜在的内漏。EVAS的早期结果良好，但尚未发表关于围手术期髂动脉解剖结构变化的数据。在这项研究中，对27名连续接受择期腹主动脉瘤EVAS修复术的患者进行了回顾性分析。特定AAA（直径、从肾动脉到主动脉分叉的长度、肾上和肾下颈成角、AAA体积、血栓体积和流动管腔体积）和髂动脉特征（长度，角度，最严重成角的位置参考髂总动脉的起源），从术前和术后确定。结果：在30天随访时未观察到I型或II型内漏。腹主动脉瘤总体积、肾上和肾下成角以及主动脉瘤颈直径在EVAS后没有显著变化。AAA血流管腔显著增加（平均差异4.4 mL，95% CI 2.0 - 8.6 mL），AAA血栓体积减少（平均差异3.2 mL，95% CI 2.0 - 1.1 mL）。AAA长度（125.7 mm vs. 123.1 mm），左髂总动脉长度（57.6 mm vs. 55.3 mm），以及右侧和左侧最大髂动脉成角（右侧37.4 vs. 32.2;左侧：43.9 vs. 38.4）显著降低，EVAS后最大成角位置距离髂动脉起点更远，结论：EVAS后大多数髂动脉解剖特征保持不变。将腔内袋填充至180 mmHg的压力可能导致某些患者的血栓体积损失，这可能是因为液体被挤压到腰动脉或肠系膜下动脉中。EVAS前后髂髂动脉长度的绝对差异很小，因此术前尺寸测量可准确确定支架长度。2015年欧洲血管外科学会。由爱思唯尔有限公司出版。保留所有权利。
Objective: Endovascular aortic sealing (EVAS) with the Nellixendosystem (Endologix, Irvine, CA, USA) is a new concept to treat infrarenal abdominal aortic aneurysms (AAAs). By sealing the aneurysm, potential endoleaks may be avoided. Early results of EVAS are good, but no data have been published regarding peri-procedural changes in aortoiliac anatomy. In this study, 27 consecutive patients who underwent elective EVAS repair of an AAA were reviewed.Method: Specific AAA (diameter, length from renal arteries to aortic bifurcation, supra- and infrarenal neck angulation, AAA volume, thrombus volume, and flow lumen volume), and iliac artery characteristics (length, angulation, location of most severe angulation with reference to the origin of the common iliac artery) were determined from pre- and post -procedural reconstructed computed tomography angiograms.Results: No type I or II endoleaks were seen at 30 day follow up. Total AAA volume, suprarenal and infrarenal angulation, as well as aortic neck diameter did not change significantly post-EVAS. AAA flow lumen increased significantly (mean difference 4.4 mL, 95% CI 2.0 to 8.6 mL) and AAA thrombus volume decreased (mean difference 3.2 mL, 95% CI 2.0 to 1.1 mL). AAA length (125.7 mm vs. 123.1 mm), left common iliac artery length (57.6 mm vs. 55.3 mm), and right and left maximum iliac artery angulation (right 37.4 vs. 32.2; left: 43.9 vs. 38.4) were reduced significantly and the location of maximum angulation was further from the iliac artery origin post-EVAS, suggesting slight straightening of the aortoiliac anatomy.Conclusion: Most aortoiliac anatomic characteristics remained unchanged post-EVAS. Filling of the endobags to a pressure of 180 mmHg may lead to lost thrombus volume in some patients, probably because liquid is squeezed into lumbar or the inferior mesenteric artery. The absolute differences in pre- and post-EVAS aortoiliac lengths were small, so pre -operative sizing is accurate for determining stent length. 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.