Endovascular Aneurysm Sealing (EVAS) and Chimney EVAS in the Treatment of Failed Endovascular Aneurysm Repairs
Endovascular Aneurysm Sealing (EVAS) and Chimney EVAS in the Treatment of Failed Endovascular Aneurysm Repairs
复制标题
DOI：
10.1177/1526602816675622
复制
发表时间：
2017-02-01
影响因子：
2.6
通讯作者：
Dorweiler, Bernhard
中科院分区：
文献类型：
--
作者：
Youssef, Marwan;Zerwes, Sebastian;Dorweiler, Bernhard
目的：评价Nellix血管内动脉瘤密封（EVAS）系统治疗血管内动脉瘤修复（EVAR）术后并发症的技术成功和临床效果。方法：于2014年3月至2015年12月在2家医院连续15例（平均年龄79岁，男性14例）既往有EVAR的患者接受EVAS治疗。先前失败的EVARs包括13例分岔内移植物，1例分岔内移植物加开窗袖带，1例管内移植物。Endoleaks是主要适应症：Ia型10例，III型5例（IIIa型3例，IIIb型2例）。所有患者均表现为进行性主动脉瘤（中位直径7.85 cm，范围6.5-11）。8例患者接受紧急治疗（6例有症状的动脉瘤，2例有破裂）。所有的患者都接受了Nellix修复失败的支架；由于近端着陆区不足，10例采用烟囱（Ch）程序结合EVAS （chEVAS）。结果：技术成功率100%。所有的裂缝都被成功密封，不需要额外的干预。EVAS或chEVAS后未见进一步渗漏。1例出现囊内突出，无后遗症。1例老年动脉瘤破裂患者术后2个月死于多器官功能衰竭。一例肾动脉导丝损伤因活动性出血而行肾切除术。在中位随访8个月（范围3-24个月）期间，未观察到再干预、动脉瘤相关死亡、移植物血栓形成、内漏或烟囱移植物闭塞。结论：目前的初步经验表明，EVAS/chEVAS治疗EVAR失败是可行的。当其他既定方法不可行或不可用时，该技术可作为救助或替代治疗。
Purpose: To assess the technical success and clinical outcome of reinterventions using the Nellix Endovascular Aneurysm Sealing (EVAS) System to treat complications after endovascular aneurysm repair (EVAR). Methods: Fifteen consecutive patients (mean age 79 years; 14 men) with prior EVAR were treated with EVAS between March 2014 and December 2015 at 2 institutions. The failed prior EVARs included 13 bifurcated endografts, 1 bifurcated graft plus fenestrated cuff, and 1 tube endograft. Endoleaks were the predominant indications: type Ia in 10 and type III in 5 (3 type IIIa and 2 type IIIb). All patients presented with progressive aortic aneurysms (median 7.85-cm diameter; range 6.5-11). Eight patients were treated on an urgent or emergency basis (6 symptomatic aneurysms and 2 contained ruptures). All patients underwent Nellix relining of the failed stent-graft; 10 had chimney (Ch) procedures in combination with EVAS (chEVAS) because the proximal landing zones were inadequate. Results: Technical success was 100%. All endoleaks were successfully sealed, and no additional intervention was required. No further endoleak after EVAS or chEVAS was recorded. Endobag protrusion occurred in 1 case without sequelae. One elderly patient with ruptured aneurysm died from multiple organ failure 2 months postoperatively. One renal artery guidewire injury led to nephrectomy because of active bleeding. No reinterventions, aneurysm-related mortalities, graft thrombosis, endoleaks, or chimney graft occlusions were observed during a median follow-up of 8 months (range 3-24). Conclusion: The present preliminary experience demonstrates that the use of EVAS/chEVAS is feasible for treatment of failed EVAR. This technique may be used as bailout or an alternative treatment when other established methods are infeasible or not available.