Type III endoleaks in complex endovascular abdominal aortic aneurysm repair within the Vascular Quality Initiative.
Type III endoleaks in complex endovascular abdominal aortic aneurysm repair within the Vascular Quality Initiative.
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DOI：
10.1016/j.jvs.2021.10.038
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发表时间：
2022-04
影响因子：
4.3
通讯作者：
Spangler EL
中科院分区：
文献类型：
--
作者：
Blakeslee-Carter J;Beck AW;Spangler EL
腹主动脉瘤复杂腹主动脉瘤腔内修复术（c-EVAR）后的3型内漏（T3 EL）由于相对罕见，历来难以研究。标准肾下腹主动脉瘤腔内修复术中的既往研究发现T3 EL与生存率降低相关。本研究旨在评价国家多中心队列中T3 EL的发生率，识别与T3 EL发展相关的潜在手术特征，并确定其对c-EVAR临床结局的影响。在2010年1月至2020年3月期间，在血管质量倡议（VQI）中对非破裂动脉瘤的择期c-EVAR进行了回顾性队列审查。VQI标准将c-EVAR定义为肾上或肾旁腹主动脉瘤修复，采用任何胸腹修复术、开孔/分支修复术、平行支架修复术、定制制造器械和医生改良的覆膜支架。评估的终点是c-EVAR中T3 EL的发生率以及T3 EL对再次介入和生存的影响。首次内漏定义为首次住院期间发现的内漏。事件内漏定义为首次住院时不存在、随访时发现的新发内漏。2010年1月至2020年3月期间，共识别出4，070例c-EVAR病例，其中2，656例（65.2%）有适当的随访数据。一半队列使用改良或定制移植物（n= 2，055/4，070，50.5%）。3，687例患者（90.5%）使用了分支，而开窗术和烟囱技术分别记录在13%（n=533）和15.1%（n=613）中。索引T3 EL的发生率为4.1%（n=167），随访时T3 EL的发生率为0.04%（n=1）。与无T3 EL患者（49.2%，n= 1，924/3，903）相比，T3 EL患者（78.4%，n=131/167）更频繁地使用分类为定制或医生改良的器械（p<0.001）。与无T3 EL的患者相比，索引T3 EL的存在与主动脉再次介入增加或死亡率增加无统计学相关性。c-EVAR中的T3 EL仍然相对不常见，主要在首次住院时确定。T3 EL的发展与更高的器械模块化和改良相关，这表明随着器械技术的不断进步和变得更加复杂，T3 EL的发生可能会持续存在并继续需要评价。在本研究中，T3 EL的存在似乎与主动脉再介入或生存率之间没有统计学显著关系，但由于事件发生率低和2型错误的可能性高，这些结果并不确定。在器械疲劳和退化的理论风险中，在延长的随访间隔和勤奋的报告中继续评价大型队列仍然至关重要。c-EVAR中的T3 EL与1年随访时的再介入或死亡率增加无关。延长报告间隔将提高充分理解T3 EL临床影响的能力。随着设备的不断发展和变得更加复杂，T3 EL的发生将继续需要谨慎的管理。
Type 3 Endoleaks (T3EL) following complex EVAR (c-EVAR) for abdominal aortic aneurysm have been historically difficult to study due to their relative rarity. Previous studies within standard infrarenal EVAR have found an association between T3EL and decreased survival. This study aims to evaluate the occurrence of T3EL in a national multicenter cohort, identify potential procedural characteristics associated with T3EL development, and determine their impact on clinical outcomes in c-EVAR. A retrospective cohort review was conducted of elective c-EVAR for non-ruptured aneurysms within the Vascular Quality Initiative (VQI) between January 2010 and March 2020. The VQI standards define c-EVAR as suprarenal or pararenal AAA repaired with any thoracoabdominal repairs, fenestrated/branched repairs, parallel stent repairs, custom manufactured devices, and physician modified endografts. End-points assessed were rates of T3EL within c-EVAR, and impact of T3EL on reintervention and survival. Index endoleaks were defined as endoleaks discovered during index hospitalization. Incident endoleaks were defined as new endoleaks, that were not present at index hospitalization, discovered at follow-up. 4,070 c-EVAR cases were identified between January 2010 and March 2020, of which, 2,656 (65.2%) had appropriate follow-up data. Half the cohort had a modified or custom graft (n=2,055/4,070, 50.5%). Branches were employed in 3,687 patients (90.5%), while fenestrations and chimney techniques were documented in 13% (n=533) and 15.1% (n=613) respectively. The rate of index T3EL was 4.1% (n=167), and the rate of incident T3EL at follow-up was 0.04% (n=1). Devices categorized as either custom or physician modified were utilized more frequently in patients with index T3EL (78.4%, n=131/167) compared to patients without index T3EL (49.2%, n=1,924/3,903) (p<0.001). Compared to those without T3EL, the presence of index T3EL was not statistically associated with increased aortic reinterventions or increased mortality. T3EL in c-EVAR remain relatively uncommon and are identified predominately at index hospitalization. Development of T3EL was associated with higher device modularity and modification, which suggests that as device technologies continue to advance and become more intricate the occurrence of T3EL may persist and continue to require evaluation. In this study, the presence of T3EL did not appear to have a statistically significant relationship with aortic reinterventions or survival, however these findings are not definitive due to low event rate numbers and high potential for Type 2 errors. Amid the theoretical risk of device fatigue and degeneration, continued evaluations of large cohorts at extended follow-up intervals and diligent reporting remain paramount. T3EL in c-EVAR were not associated with increased reinterventions or mortality at 1 year follow-up. Extending reporting intervals would improve ability to fully understand the clinical impact of T3EL. As devices continue to evolve and become more complex, the occurrence of T3EL will continue to require mindful management.
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影响因子：
4.3
作者：
Lal, Brajesh K.;Zhou, Wei;Freischlag, Julie
通讯作者：
Freischlag, Julie
影响因子：
4.3
作者：
O'Donnell, Thomas F. X.;Patel, Virendra I.;Schermerhorn, Marc L.
通讯作者：
Schermerhorn, Marc L.
DOI：
10.1136/bmjsit-2020-000054
发表时间：
2020-03-23
期刊：
BMJ SURGERY INTERVENTIONS & HEALTH TECHNOLOGIES
影响因子：
--
作者：
Blakeslee-Carter, Juliet;Beck, Adam;Spangler, Emily
通讯作者：
Spangler, Emily
影响因子：
4.3
作者：
Starnes, Benjamin W.;Heneghan, Rachel E.;Tatum, Billi
通讯作者：
Tatum, Billi
DOI：
10.1016/j.ejvs.2009.12.008
发表时间：
2010-05-01
影响因子：
5.7
作者：
Amiot, S.;Haulon, S.;Favre, J. -P.
通讯作者：
Favre, J. -P.