Aneurysmal Extension to the Iliac Bifurcation Increases the Risk of Complications and Secondary Procedures After Endovascular Repair of Abdominal Aortic Aneurysms
Aneurysmal Extension to the Iliac Bifurcation Increases the Risk of Complications and Secondary Procedures After Endovascular Repair of Abdominal Aortic Aneurysms
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DOI：
10.1016/j.avsg.2010.01.008
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发表时间：
2010-07-01
影响因子：
1.5
通讯作者：
Barral, Xavier
中科院分区：
文献类型：
--
作者：
Albertini, Jean-Noel;Favre, Jean-Pierre;Barral, Xavier
背景资料：比较腹主动脉瘤（AAA）患者的腹主动脉瘤腔内修复术（EVAR）的结果，并没有相关的髂总动脉瘤（CIAA）延伸到髂bifurcity.Methods：回顾1999年和2007年之间接受动脉瘤腔内修复术的157例患者。第1组包括133例有或没有CIAA和合适的远端髂总颈（A、B、C或D型）的患者。第2组包括24例相关CIAA延伸至髂动脉分叉（E型）的患者。42例患者植入了覆膜支架（Endologix，Irvine，CA），55例患者植入了Zenith（Cook，比耶韦尔斯科夫，Danemark），60例患者植入了Talent（Medtronic，桑尼维尔，CA）。40例患者行腹主动脉-单侧髂动脉覆膜支架植入术。结果：总死亡率和AAA破裂率无差异。第1组和第2组5年时AAA相关无并发症生存率分别为72 +/- 5%和41 +/- 14%（p = 0.006）。第1组和第2组的无二次干预生存率分别为84 +/- 5%和55 +/- 12%（p = 0.0008）。第2组远端1型内漏和覆膜支架血栓形成的发生率分别为17%和8%，第1组分别为3.8%和0.8%（分别为p = 0.07和p = 0.01）。结论：AAA相关并发症和二次干预在E型AAA患者中更常见。远端1型内漏和覆膜支架血栓形成在这些患者中更常见。这些结果保证了更好地适用于治疗CIAAs的技术的进一步开发，例如分支和柔性覆膜支架。
Background: To compare the outcome of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with and without associated common iliac artery aneurysm (CIAA) extending to the iliac bifurcation.Methods: Review of 157 patients who underwent endovascular aneurysm repair between 1999 and 2007. Group 1 included 133 patients with and without CIAA and suitable distal common iliac neck (type A, B, C, or D). Group 2 included 24 patients with associated CIAA extending to the iliac bifurcation (type E). Stent-grafts were Powerlink (Endologix, Irvine, CA) in 42, Zenith (Cook, Bjaeverskov, Danemark) in 55, and Talent (Medtronic, Sunnyvale, CA) in 60 patients. Forty patients had aorto-uni-iliac stent-grafts.Results: No difference in overall mortality and AAA rupture was observed. AAA-related complication-free survival at 5 year was 72 +/- 5% and 41 +/- 14% in group 1 and 2, respectively (p = 0.006). Secondary intervention-free survival was 84 +/- 5% and 55 +/- 12% in group 1 and 2, respectively (p = 0.0008). Incidence of distal type 1 endoleak and stent-graft thrombosis was 17 and 8 % in group 2, 3.8 and 0.8 % in group 1, respectively (p = 0.07 and p = 0.01, respectively).Conclusion: AAA-related complications and secondary interventions occur more frequently in patients with type E AAA. Distal type 1 endoleak and stent-graft thrombosis are more frequent in these patients. These results warrant further development of technologies that are better adapted for treatment of CIAAs, such as branched and flexible stent-grafts.