Clinical Outcomes of Spinal Cord Ischemia after Fenestrated and Branched Endovascular Stent Grafting during Total Endovascular Aortic Repair for Thoracoabdominal Aortic Aneurysms
Clinical Outcomes of Spinal Cord Ischemia after Fenestrated and Branched Endovascular Stent Grafting during Total Endovascular Aortic Repair for Thoracoabdominal Aortic Aneurysms
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DOI：
10.1016/j.avsg.2017.04.025
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发表时间：
2017-10-01
影响因子：
1.5
通讯作者：
Hara, Masayuki
中科院分区：
文献类型：
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作者：
Baba, Takeshi;Ohki, Takao;Hara, Masayuki
背景资料：在这项单中心研究中，我们评估了开孔型腹主动脉腔内修复术（f-EVAR）和分支腹主动脉腔内修复术在胸腹主动脉瘤（TAAA）全腔内修复术中的发病率和死亡率的临床结局。在2006年7月至2015年6月期间，择期f-EVAR和多分支EVAR在我们机构的99例患者中进行了TAAA（t分支）（Crawford分类I型[7]、II型[13]、III型[6]、IV型[55]和V型[18]）。我们回顾性分析了44例患者（不包括Crawford IV型TAAA患者），并比较了30例采用f-EVAR治疗的患者和14例采用t-Branch治疗的患者。结果：f-EVAR的技术成功率为96.7%，t-Branch为100%，30天死亡率为3.3%，t-Branch为7.1%（P = 0.646）。t-Branch（n = 5，35.7%）的围手术期SCI发生率高于f-EVAR（n = 2，6.7%; P = 0.04）。f-EVAR（n = 9，30.0%）的内漏发生率高于t-Branch（n = 1，7.1%; P = 0.046）。f-EVAR和t-Branch 1年后无动脉瘤相关死亡率分别为96.7%和92.9%，3年后分别为88.8%和92.9%（P = 0.982）。当存在手术等危险因素时，（t-分支），最大短轴>= 65 mm，覆盖长度>= 360 mm，髂内动脉闭塞，和>= 5条牺牲的肋间动脉。我们的f-EVAR和t-Branch的初始至中期结果良好，围手术期死亡率低，无动脉瘤发生率高。相关死亡t-Branch的SCI发病率明显较高;对于有高危因素的患者，开发额外的SCI预防方法非常重要。
Background: In this single-center study, we assessed the clinical outcomes of fenestrated endovascular aortic repair (f-EVAR) and branched EVAR on morbidity and mortality during total endovascular aortic repair for thoracoabdominal aortic aneurysms (TAAAs).Methods: Between July 2006 and June 2015, elective f-EVAR and multibranched EVAR (t-Branch) for TAAAs were performed in 99 patients at our institution (Crawford classification types I [7], II [13], III [6], IV [55], and V [18]). We retrospectively analyzed 44 patients, excluding those with Crawford type IV TAAAs, and compared 30 patients treated with f-EVAR and 14 treated with t-Branch. Multivariate analysis was performed to determine the factors associated with perioperative spinal cord ischemia (SCI).Results: Technical success was 96.7% with f-EVAR and 100% with t-Branch, and the 30-day mortality rate was 3.3% with f-EVAR and 7.1% with t-Branch (P = 0.646). The incidences of perioperative SCI were higher with t-Branch (n = 5, 35.7%) than those with f-EVAR (n = 2, 6.7%; P = 0.04). Endoleaks were more prevalent with f-EVAR (n = 9, 30.0%) than with t-Branch (n = 1, 7.1%; P = 0.046). Rates of freedom from aneurysm-related death after 1 year for f-EVAR and t-Branch were 96.7 and 92.9%, respectively, and those after 3 years were 88.8 and 92.9% (P = 0.982), respectively. The risk of SCI remarkably increased in the presence of risk factors such as procedure (t-Branch), maximum short axis of >= 65 mm, coverage length of >= 360 mm, internal iliac artery occlusion, and >= 5 sacrificed intercostal arteries.Conclusions: Our initial to mid-term results of f-EVAR and t-Branch were good with low rates of perioperative mortality and high rates of freedom from aneurysm-related death. SCI incidence with t-Branch was significantly high; it is important to develop additional SCI prevention methods for patients with high-risk factors.