Device migration after endovascular abdominal aortic aneurysm repair: Experience with a talent Stent-Graft
Device migration after endovascular abdominal aortic aneurysm repair: Experience with a talent Stent-Graft
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DOI：
10.1097/01.rvi.0000142601.10673.00
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发表时间：
2004-12-01
影响因子：
2.9
通讯作者：
Ashleigh, RJ
中科院分区：
文献类型：
--
作者：
England, A;Butterfield, JS;Ashleigh, RJ
目的：主动脉瘤腔内修复术（EVAR）后，器械移位（DM）可能导致晚期失效。腹主动脉瘤腔内修复术后的计算机断层扫描（CT）进行了审查，以确定DM的频率和是否可以预测。材料和方法：55例患者接受腹主动脉瘤腔内修复术与人才覆膜支架肾上固定。定期采用固定方案进行CT检查。审查了患者人口统计学、风险因素、手术细节和随访事件。两名观察员，彼此不知情，审查轴向图像和多平面重建的CT扫描。DM定义为：参考血管（腹腔动脉轴/上级肠系膜动脉）与近端器械之间的距离变化10 mm。随访时间至少为2年（平均3年，范围2-5年）。结果：2年内38例患者中有6例（15.8%）检出糖尿病。19例患者在3年时没有新发迁移病例，但6例患者在4年时有1例新发迁移病例（16.6%）。2年内的平均移位为4.8 mm +/- 4.2 mm。1例DM患者发生I型内漏，需要再次介入。该患者进一步发生内漏，并在手术后因破裂死亡。顶部颈部扩大是唯一的预测因素，目前在71%的DM患者（P = 0.056）。结论：DM发生在一小部分患者，更紧密的随访间隔可能是必要的，在患者短/扩大近端颈部。
PURPOSE: Device migration (DM) may cause late failure after endovascular aortic aneurysm repair (EVAR). Computed tomography (CT) scans following EVAR were reviewed to establish the frequency of DM and whether it can be predicted.MATERIALS AND METHODS: Fifty-five patients underwent EVAR with a Talent stent-graft with suprarenal fixation. CT with a fixed protocol was performed at regular intervals. Patient demographics, risk factors, procedure details, and follow-up events were reviewed. Two observers, blinded to each other, reviewed axial images and mutliplanar reformats of the CT scans. DM was defined as a change of : 10 mm in the distance between a reference vessel (celiac axis/superior mesenteric artery) and the proximal device. Follow-up was performed for a minimum of 2 years (mean, 3 years; range, 2-5 years).RESULTS: DM was detected in six of 38 patients (15.8%) by 2 years. There were no new cases of migration in the 19 patients at 3 years but one new case in the six patients at 4 years (16.6%). Mean migration over 2 years was 4.8 mm +/- 4.2 mm. One patient with DM developed a type I endoleak that required reintervention. This patient developed a further endoleak and died following surgery for rupture. Top neck enlargement was the only predictive factor identified, present in 71% of patients with DM (P =.056).CONCLUSION: DM occurred in a small proportion of patients; closer follow-up intervals may be necessary in patients with short/enlarging proximal necks.