Early and Midterm Outcomes of Chimney Endovascular Aortic Repair for Ruptured Abdominal Aortic Aneurysms.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Yuriko Takeuchi, Noriyasu Morikage, Ryunosuke Sakamoto, Ryo Otsuka, Soichi Ike, Takahiro Mizoguchi, Makoto Samura, Takasuke Harada, Hiroshi Kurazumi, Ryo Suzuki, Kotaro Suehiro, Kimikazu Hamano
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引用次数: 0

Abstract

Purpose: To compare the outcomes of endovascular aortic aneurysm repair using a chimney technique (ch-EVAR) with those of the standard EVAR (st-EVAR) for ruptured abdominal aortic aneurysms (RAAA).

Materials and methods: We implemented ch-EVAR for juxtarenal RAAA based on obvious anatomical indications after converting the strategy for RAAA from open repair to EVAR. A retrospective, cohort-based study was conducted on patients with RAAA who were treated using EVAR in our hospital between July 2011 and March 2022. EVAR cases were extracted, and outcomes were compared between ch-EVAR and st-EVAR. Patient clinical status, anatomical variables, treatment, and follow-up data were evaluated.

Results: A total of 56 (82%) and 12 (18%) patients were treated by st-EVAR and ch-EVAR, respectively. Thirty-day mortality rates were comparable between the 2 groups [8.9% in st-EVAR vs 8.3% in ch-EVAR (p= 0.95)]. Short-term outcomes showed that no type Ia endoleak occurred in either group. Midterm outcomes, including sac enlargement [7.5% in st-EVAR vs 0% in ch-EVAR (p= 0.37)], shrinkage [77.5% in st-EVAR vs 80.0% in ch-EVAR (p= 0.86)], and overall survival and freedom from aneurysm-related reintervention at 3 years [64.7% and 96.4% in the EVAR group vs 91.7% and 100% in the ch-EVAR group, respectively (p= 0.30 and 0.52)], were not significantly different between the 2 groups.

Conclusion: Ch-EVAR for RAAA showed remarkably excellent outcomes, comparable to those of st-EVAR. Ch-EVAR is considered technically feasible in experienced centers. The indications for EVAR for RAAA may be further expanded using the chimney technique, resulting in overall improved outcomes for RAAA.

Clinical impact: This is a retrospective, single-center analysis of 68 patients with ruptured abdominal aortic aneurysms (RAAAs) treated by endovascular repair (EVAR) to investigate the efficacy of the chimney technique for juxtarenal RAAA. Thirty-day mortality rate was 8.3% for the chimney EVAR group, which was equivalent to that in the standard EVAR group. Mid-term outcomes including sac enlargement/shrinkage, overall survival, and freedom from aneurysm-related reintervention were comparable between the two groups. This report suggests the possibility of broadening the selection criteria of the current endovascular strategy using the chimney technique.

用烟囱式血管内主动脉修补术治疗破裂的腹主动脉瘤的早期和中期疗效。
目的:比较使用烟囱技术(ch-EVAR)和标准 EVAR(st-EVAR)对破裂的腹主动脉瘤(RAAA)进行血管内主动脉瘤修复的效果:我们将腹主动脉瘤破裂的手术策略从开放式修复转变为EVAR后,根据明显的解剖学指征对并arenal RAAA实施了ch-EVAR。我们对 2011 年 7 月至 2022 年 3 月期间在我院接受 EVAR 治疗的 RAAA 患者进行了一项基于队列的回顾性研究。研究提取了EVAR病例,并比较了ch-EVAR和st-EVAR的治疗效果。对患者的临床状态、解剖变量、治疗和随访数据进行了评估:共有56名(82%)和12名(18%)患者分别接受了st-EVAR和ch-EVAR治疗。两组患者的 30 天死亡率相当[st-EVAR 为 8.9% vs ch-EVAR 为 8.3% (p=0.95)]。短期结果显示,两组均未发生 Ia 型内漏。中期结果包括囊肿扩大[st-EVAR 为 7.5% vs ch-EVAR 为 0% (p=0.37)]、缩小[st-EVAR 为 77.5% vs ch-EVAR 为 80.0% (p=0.86)]、3 年后总生存率和无动脉瘤相关再介入[st-EVAR 为 64.7% vs ch-EVAR 为 96.4%]。EVAR组的64.7%和96.4% vs ch-EVAR组的91.7%和100%(p= 0.30和0.52)],两组间无显著差异:结论:Ch-EVAR治疗RAAA的疗效非常好,可与st-EVAR媲美。结论:Ch-EVAR治疗RAAA的疗效非常好,与st-EVAR的疗效不相上下。使用烟囱技术可进一步扩大EVAR治疗RAAA的适应症,从而改善RAAA的总体疗效:这是一项回顾性单中心分析,研究对象是68例接受血管内修复术(EVAR)治疗的腹主动脉瘤(RAAA)破裂患者,目的是研究烟囱技术对并arenal RAAA的疗效。烟囱EVAR组的30天死亡率为8.3%,与标准EVAR组相当。两组的中期疗效(包括囊肿增大/收缩、总生存率和无动脉瘤相关再介入)相当。该报告提示了使用烟囱技术扩大目前血管内策略选择标准的可能性。
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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来源期刊
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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