Fenestrated Endovascular Grafting: The French Multicentre Experience
Fenestrated Endovascular Grafting: The French Multicentre Experience
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DOI：
10.1016/j.ejvs.2009.12.008
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发表时间：
2010-05-01
影响因子：
5.7
通讯作者：
Favre, J. -P.
中科院分区：
文献类型：
--
作者：
Amiot, S.;Haulon, S.;Favre, J. -P.
目的：本研究的目的是评估主动脉瘤修复术后的中期结果，使用开孔型endograftsperformed在16个法国学术centers.Materials和方法：前瞻性收集的数据进行了回顾性分析。本研究包括2004年5月至2009年1月期间在法国接受开孔型覆膜支架治疗的所有患者。患者被判定为开放手术修复的高风险。开孔型覆膜支架的设计使用了在三维（3D）工作站上进行的计算机断层扫描（CT）重建。所有患者在出院时、6个月、12个月、18个月和24个月以及此后每年进行CT、双功超声和平片X线片评估。中位年龄和动脉瘤尺寸分别为73岁（范围48 - 91岁）和56 mm（范围45 - 91 mm）。共403条内脏血管通过织物开窗灌注，其中包括265条肾动脉。需要1例早期转为开放手术。完成血管造影和出院CT扫描显示398/403（99%）和389/394（99%）的靶血管通畅。30天死亡率为2%（3/134）。出院前成像确定了16例（12%）内漏：3例I型、12例II型和1例III型。术后，分别有4例（3%）和2例（1%）患者需要进行短暂或永久性透析。中位随访时间为15个月（范围2 - 53个月）。在随访期间，没有动脉瘤破裂或需要开放转换。131例患者中有12例（9%）在随访期间死亡（12个月和24个月的精算生存率分别为93%和86%）。从手术到死亡的中位时间为15个月。这些死亡均与动脉瘤无关。在1年、2年和3年时，分别有52%、65.6%和75%的患者动脉瘤囊尺寸减小超过5 mm。3例（4%）患者在第一年内发生囊扩大，与持续性内漏相关。在随访期间，检测到4例肾动脉闭塞。在随访期间，12例患者共进行了12次手术相关的再干预，包括6次纠正内漏，5次纠正受威胁的内脏vessel.Conclusions：使用血管内假体与移植材料结合内脏动脉是安全有效的，在中期内防止破裂。在这个高风险队列的随访期间，描述了可预测的高死亡率。中期随访以评估囊行为和内脏口对于确保最佳结果至关重要。(C)2009年欧洲血管外科学会。由爱思唯尔有限公司出版。保留所有权利。
Purpose: This study aims to evaluate the medium-term outcomes following aortic aneurysm repair using fenestrated endograftsperformed in 16 French academic centres.Materials and methods: A retrospective analysis of prospectively collected data was carried out. This study included all patients treated with fenestrated endografts in France between May 2004 and January 2009. Patients were judged to be at high risk for open surgical repair. Fenestrated endografts were designed using computed tomography (CT) reconstructions performed on three-dimensional (3D) workstations. All patients were evaluated with CT, duplex ultrasound and plain film radiograph at discharge, 6, 12, 18 and 24 months, and annually thereafter.Results: A total of 134 patients (129 males) were treated over the study period. Median age and aneurysm size were 73 years (range 48-91 years) and 56 mm (range 45-91 mm), respectively. A total of 403 visceral vessels were perfused through a fabric fenestration, including 265 renal arteries. One early conversion to open surgery was required. Completion angiography and discharge CT scan showed that 398/403 (99%) and 389/394 (99%) respective target vessels were patent. The 30-day mortality rate was 2% (3/134). Pre-discharge imaging identified 16 (12%) endoleaks: three type I, 12 type II and one type III. After the procedure, transient or permanent dialysis was required in four (3%) and two (1%) patients, respectively. The median duration of follow-up was 15 months (range 2-53 months). No aneurysms ruptured or required open conversion during the follow-up period. Twelve of 131 patients (9%) died during follow-up (actuarial survival at 12 and 24 months: 93% and 86%, respectively). Median time from procedure to death was 15 months. None of these deaths were aneurysm related. Aneurysm sac size decreased by more than 5 mm in 52%, 65.6% and 75% of patients at 1, 2 and 3 years, respectively. Three (4%) patients had sac enlargement within the first year, associated with a persistent endoleak. During follow-up, four renal artery occlusions were detected. A total of 12 procedure-related re-interventions were performed in 12 patients during follow-up, including six to correct endoleaks, and five to correct threatened visceral vessels.Conclusions: The use of endovascular prostheses with graft material incorporating the visceral arteries is safe and effective in preventing rupture in the medium term. A predictable high mortality rate was depicted during follow-up in this high-risk cohort. Meticulous follow-up to assess sac behaviour and visceral ostia is critical to ensure optimal results. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.