Standard off-the-shelf versus custom-made multibranched thoracoabdominal aortic stent grafts
Standard off-the-shelf versus custom-made multibranched thoracoabdominal aortic stent grafts
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DOI：
10.1016/j.jvs.2015.11.035
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发表时间：
2016-05-01
影响因子：
4.3
通讯作者：
Hiramoto, Jade S.
中科院分区：
文献类型：
--
作者：
Fernandez, Charlene C.;Sobel, Julia D.;Hiramoto, Jade S.
目的：胸腹主动脉瘤（TAAA）和肾旁主动脉瘤（PRAA）复杂的主动脉分支解剖结构对腔内修复术提出了挑战。使用定制分支覆膜支架（CSG）配置时，多分支血管内器械具有持久的中期结果。使用标准分支覆膜支架（SSG）配置的中期结果未知，但其具有现成技术的优势。本研究的目的是比较CSG和SSG多分支血管内device.Methods的中期结局：从2005年7月至2014年9月，133例患者在前瞻性试验中接受了TAAA和PRAA的择期血管内修复术。从2008年12月开始，SSGs被用于那些与合适的anatomy.Results：50例患者（平均年龄，71 6 7岁，11名妇女[22%]）使用SSGs治疗，和83例患者（平均年龄，74 6 9岁，22名妇女[26.5%]）进行修复使用CSG。SSG和CSG组在动脉瘤大小、动脉瘤范围和医学合并症方面相似，唯一的例外是肺部疾病，这在SSG组中更常见。所有覆膜支架均按预期展开，未转为开放性修复术。SSG组和CSG组的平均6标准差随访（天）分别为694 6 525和942 6 764（P = 0.045）。两组患者在肾衰竭相关死亡、需要透析的肾衰竭、卒中、内漏、内脏或肾分支闭塞、下肢无力或再次介入方面无显著差异（均P > 0.05）。与CSG相比，SSG患者的造影剂体积显著较低（P = 0.016），但手术或透视时间无显著差异。与CSG患者相比，SSG患者的治疗时间（从同意手术到手术的天数）显著较短（P = 0.01）。结论：对于解剖结构合适的患者，使用SSG进行TAAA和PRAA修复可显著缩短手术等待时间，并且与CSG相比，在中期内安全、有效且耐用。
Objective: The complex aortic branch anatomy in thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs) presents a challenge for endovascular repair. The multibranched endovascular device has durable midterm results with use of a custom branch stent graft (CSG) configuration. The midterm results with use of the standard branch stent graft (SSG) configuration are unknown, but it has the advantage of off-the-shelf technology. The goal of this study was to compare the midterm outcomes of CSG and SSG multibranched endovascular devices.Methods: From July 2005 to September 2014, 133 patients underwent elective endovascular repair of TAAA and PRAA in a prospective trial. Beginning in December 2008, SSGs were used in those with suitable anatomy.Results: Fifty patients (mean age, 71 6 7 years; 11 women [22%]) were treated using SSGs, and 83 patients (mean age, 74 6 9 years; 22 women [26.5%]) underwent repair using CSGs. The SSG and CSG groups were similar with regard to aneurysm size, aneurysm extent, and medical comorbidities, with the sole exception of lung disease, which was more common in the SSG group. All stent grafts were deployed as intended, with no conversions to open repair. Mean 6 standard deviation follow-up (days) was 694 6 525 for the SSG group and 942 6 764 for the CSG group (P = .045). There were no significant differences in aneurysm-related death, renal failure requiring dialysis, stroke, endoleak, visceral or renal branch occlusion, lower extremity weakness, or reintervention (P > .05 for each). The volume of contrast material was significantly lower in those with SSGs compared with CSGs (P = .016), but there were no significant differences in operative or fluoroscopy times. Time to treatment (days from consent to surgery) was significantly lower in SSG patients compared with CSG patients (P = .01).Conclusions: For patients with suitable anatomy, the use of SSGs for TAAA and PRAA repair results in significantly shorter wait times to surgery and is as safe, effective, and durable in the midterm compared with CSGs.