Complex abdominal aortic aneurysms: a review of radiological and clinical assessment, endovascular interventions, and current evidence of management outcomes.

BJR open Pub Date : 2024-08-22 eCollection Date: 2024-01-01 DOI:10.1093/bjro/tzae024
Girija Agarwal, Mohamad Hamady
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Abstract

Endovascular aortic aneurysm repair (EVAR) is an established approach to treating abdominal aortic aneurysms, however, challenges arise when the aneurysm involves visceral branches with insufficient normal segment of the aorta to provide aneurysm seal without excluding those vessels. To overcome this, a range of technological developments and solutions have been proposed including fenestrated, branched, physician-modified stents, and chimney techniques. Understanding the currently available evidence for each option is essential to select the most suitable procedure for each patient. Overall, the evidence for fenestrated endovascular repair is the most comprehensive of these techniques and shows an early post-operative advantage over open surgical repair (OSR) but with a catch-up mortality in the mid-term period. In this review, we will describe these endovascular options, pre- and post-procedure radiological assessment and current evidence of outcomes.

复杂的腹主动脉瘤:放射学和临床评估、血管内介入治疗以及当前治疗效果证据的综述。
血管内主动脉瘤修补术(EVAR)是一种治疗腹主动脉瘤的成熟方法,然而,当动脉瘤涉及内脏分支,而主动脉的正常段不足以在不排除这些血管的情况下提供动脉瘤密封时,就会出现挑战。为了克服这一问题,人们提出了一系列技术发展和解决方案,包括栅栏式支架、分支支架、医生改良支架和烟囱技术。了解每种方案的现有证据对于为每位患者选择最合适的手术至关重要。总体而言,在这些技术中,栅栏式血管内修复术的证据最为全面,与开放手术修复术(OSR)相比,栅栏式血管内修复术在术后早期具有优势,但在中期死亡率会赶超开放手术修复术。在这篇综述中,我们将介绍这些血管内修复方案、术前术后放射学评估以及目前的疗效证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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