Continued expansion of aortic necks after endovascular repair of abdominal aortic aneurysms
Continued expansion of aortic necks after endovascular repair of abdominal aortic aneurysms
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DOI：
10.1016/s0741-5214(98)70127-2
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发表时间：
1998-09-01
影响因子：
4.3
通讯作者：
Chaikof, EL
中科院分区：
文献类型：
--
作者：
Matsumura, JS;Chaikof, EL
背景：纵向研究表明，肾下腹主动脉瘤(AAA)近端的主动脉节段在标准的动脉瘤修复后有继续扩大的风险。同样，初步报告显示腔内修复后一侧或两侧的主动脉颈扩张。尽管一些研究人员认为这可能是一种暂时的影响，但移植物附着部位的持续扩张可能会影响整体装置的稳定性。方法：作为多机构血管内移植治疗AAA的多机构试验的一部分，自1993年2月至1995年1月，59例患者成功地植入了直形内移植物。对主动脉颈大小进行了形态计量学分析，并对截至1997年4月的计算机断层扫描进行了系列回顾。测量了两个移植物附着部位的颈部大小，调查人员对患者身份和扫描日期视而不见。定义小径的变化，计算年间隔扩张率，并将这些数据与内漏、装置移位、动脉瘤大小变化、内移植物直径、附着体系统骨折和初始植入前颈部大小相关联。结果：AAA修复后至少24个月观察到显著的主动脉颈增大，尤其是在远端颈部水平。第一年和第二年主动脉颈近端的年间隔扩张率分别为0.7±2.1 mm/年(P=0.023)和0.9+/-1.9 mm/年(P=0.008)。观察期内远端颈膨大更为明显，相应的年膨胀率为1.7+/-2.9 mm/年(P
Background: Longitudinal studies have revealed that the aortic segment proximal to an infrarenal abdominal aortic aneurysm (AAA) is at risk for continued enlargement after a standard aneurysm repair. Similarly, preliminary reports have shown expansion of one or both aortic necks after endovascular repair. Although some investigators have suggested that this may be a transient effect, continued dilatation at the endograft attachment site could effect the overall device stability.Methods: As part of a multi-institutional trial of endovascular grafting for the treatment of AAA, 59 patients were successfully implanted with straight endografts between February 1993 and January 1995. A morphometric analysis of aortic neck size was undertaken with serial review of computed tomography scans available through April 1997. The neck sizes at both graft attachment sites were measured, with investigators blinded to patient identity and date of scan. Changes in minor diameter were defined, annual interval expansion rates were calculated, and the data were correlated with endoleak, device migration, aneurysm size change, endograft diameter, attachment system fractures, and initial preimplant neck size.Results: Significant aortic neck enlargement, particularly at the level of the distal neck, was observed for at least 24 months after AAA repair. The annual interval dilation rates of the proximal aortic neck were 0.7 +/- 2.1 mm/year (P = .023) and 0.9 +/- 1.9 (P = .008) mm/year during the first and second years, respectively. Enlargement of the distal neck during the observation period was more marked, with corresponding annual expansion rates of 1.7 +/- 2.9 mm/year (P