Endovascular management of pararenal aortic aneurysms with multiple overlapping uncovered stents
Endovascular management of pararenal aortic aneurysms with multiple overlapping uncovered stents
复制标题
使用多个重叠的未覆盖支架对肾旁主动脉瘤进行血管内治疗
DOI：
10.1016/j.jvs.2013.02.248
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发表时间：
2013-09-01
影响因子：
4.3
通讯作者：
Jing, Zai-Ping
中科院分区：
文献类型：
--
作者：
Zhang, Yong-Xue;Lu, Qing-Sheng;Jing, Zai-Ping
目的：本研究旨在评价多孔支架系统治疗复杂主动脉瘤的安全性和有效性。方法：回顾性分析2010年2月至2011年12月在我中心接受多个重叠无覆膜支架治疗的所有主动脉瘤患者的资料。记录术前特征、术中细节和随访结果。技术成功定义为支架成功展开至目标位置，无手术相关并发症。临床成功的特征是动脉瘤完全收缩或稳定，保留重要分支，没有重大并发症。根据动脉瘤血栓形成的速度，将患者分为快速血栓形成组（完全血栓形成所需的6个月内达到动脉瘤囊完全血栓形成）。可能影响血栓形成速度的因素进行了统计分析与Fisher精确检验和t-test.Results：这种多孔支架系统被用来治疗34例患者（23名男性，11名女性，平均年龄，65.7岁）。所有患者均获得技术成功（100%）。29例患者定期随访6个月以上（平均随访时间为11.4个月）。在24例患者（83%）中观察到12个月内动脉瘤囊完全血栓形成。7名患者（24%）记录了动脉瘤收缩，21名患者（72%）稳定。所有裸支架覆盖的分支动脉在随访期间保持通畅。随访组临床成功率达97%。迟发性血栓形成的危险因素包括植入的支架较少（P = 0.013）、囊入口较长（P = 0.043）和使用抗血小板药物（P = 0.040）。结论：使用重叠裸支架治疗复杂主动脉瘤似乎是可行的，这种方法可以防止动脉瘤生长，同时保留重要分支。我们的研究的短期结果似乎令人鼓舞，但不足以得出一个强有力的结论。进一步的血流动力学和临床研究是必要的，以评估长期疗效。
Objective: This study aims at evaluating the safety and efficacy of a porous stent system consisting of multiple overlapping uncovered stents in the treatment of complex aortic aneurysms with vital branches.Methods: Data of all patients with aortic aneurysms treated in our center with multiple overlapping uncovered stents between February 2010 and December 2011 were retrospectively reviewed. Preoperative characteristics, intraoperative details, and follow-up outcomes were documented. Technical success was defined as successful deployment of the stents to target locations without procedure-related complications. Clinical success was characterized by complete shrinkage or stabilization of the aneurysm, preservation of vital branches, and absence of major complications. Patients were grouped, according to rapidity of aneurysm thrombosis, into fast-thrombosis group (complete thrombosis of aneurysmal sac was achieved in 6 months required for complete thrombosis). Possible factors affecting the speed of thrombosis were analyzed statistically with the Fisher exact test and the t-test.Results: This porous stent system was used to treat 34 patients (23 men, 11 women; mean age, 65.7 years). Technical success was achieved in all patients (100%). Regular follow-up over 6 months was achieved in 29 patients (mean length of follow-up, 11.4 months). Complete thrombosis of the aneurysm sac within 12 months was observed in 24 patients (83%). Aneurysm shrinkage was documented in seven patients (24%) and stabilization in 21 (72%). All branch arteries covered by bare stents stayed patent during follow-up. The overall clinical success rate reached 97% in the follow-up group. Risk factors for delayed thrombosis included fewer stents implanted (P = .013), longer sac entrance (P = .043), and use of antiplatelet medication (P = .040).Conclusions: An alternative method of management of complicated aortic aneurysm appears to be feasible using overlapping bare stents, which may prevent aneurysm growth while preserving vital branches. The short-term outcome of our study seems encouraging but is not sufficient to draw a robust conclusion. Further hemodynamic and clinical studies are warranted to evaluate long-term efficacy.