Physician-Modified Endografts for Non-deferrable Complex Abdominal Aortic Aneurysm Repair Using the Endurant Platform: Templates and Initial Results.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Francisco Álvarez Marcos, Andrés Reyes Valdivia, Mariano De Blas Bravo, Manuel Alonso Pérez
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引用次数: 0

Abstract

Introduction and objectives: Complex abdominal aortic aneurysm (AAA) repair often requires the use of fenestrated and branched endografts, which can be influenced by factors such as device availability, cost, and operator expertise. This study aims to evaluate the preliminary results with physician-modified endografts (PMEGs) utilizing the Medtronic Endurant platform.

Methods: Retrospective analysis of consecutive patients unsuitable for other techniques or custom-made devices, in which a PMEG Endurant was used for repair between 2021 and 2024. Bidimensional templates of the Endurant endograft were developed to ensure precise fenestration placement, which was confirmed intraoperatively with a 3D-printed aortic template. Endpoints were technical success, mortality, reinterventions, and target vessel patency.

Results: Thirty-seven target vessels in 18 patients (mean age 79.4 ± 9 years, 94% male) were treated with Endurant main bodies (n=10, 55.6%), abdominal tubes (n=4, 22.2%), or aortic extensions (n=4, 22.2%). Mean aneurysm diameter was 70.0 ± 23 mm. Mean number of fenestrations was 2.1 ± 1 (33.3% 3-FEN or 4-FEN). The most frequent bridging stents were iCover (n=15, 40.5%), BeGraft (n=10, 27.0%), and VBX (n=9, 24.3%). Mean implantation time was 198.9 ± 90 minutes. Technical success was achieved in all but one case (n=17, 94%), with no 30 day mortality, no reinterventions, and 100% target vessel patency at a median follow-up of 10 months. Three patients (16.7%) died of non aortic-related causes. One residual type IA endoleak was adverted in computed tomography scan controls and was left untreated according to patient's decision.

Conclusion: PMEG utilizing the Medtronic Endurant endograft, supported by bidimensional templates and 3D-printed confirmation models, provided safe and effective short-term outcomes for complex, non-deferrable AAA repair. Long-term data and a prospective study on PMEG with a standardized protocol would allow for evidence to arise on this technique, facilitating adequate comparisons with custom-made and off-the-shelf devices.

Clinical impact: This short series highlights the initial outcomes of physician-modified endografts (PMEG) using the Medtronic Endurant platform. Dedicated 2D templates for all Endurant sizes are provided as supplementary material, offering valuable assistance to practitioners in the vascular community. A standardized modification protocol, based on these templates along with the double-check of a sterile 3D-printed model, has allowed to achieve satisfactory short term outcomes. These outcomes are comparable to those of custom-made devices, even in scenarios requiring non-deferrable repairs and involving challenging anatomic constraints, such as type 1A endoleaks.

使用持久平台进行不可延期的复杂腹主动脉瘤修复的医师改良内移植物:模板和初步结果。
简介和目的:复杂腹主动脉瘤(AAA)的修复通常需要使用开窗和分支内移植物,这可能受到设备可用性、成本和操作人员专业知识等因素的影响。本研究旨在评估使用美敦力endurance平台的医师改良内移植物(PMEGs)的初步结果。方法:回顾性分析2021 - 2024年间连续使用PMEG enduurant进行修复的不适合其他技术或定制器械的患者。开发了Endurant内移植物的二维模板,以确保精确的开窗位置,术中使用3d打印主动脉模板证实了这一点。终点是技术成功、死亡率、再干预和靶血管通畅。结果:18例患者37根靶血管(平均年龄79.4±9岁,男性94%)采用了耐力主体(n=10, 55.6%)、腹管(n=4, 22.2%)或主动脉扩张(n=4, 22.2%)治疗。平均动脉瘤直径为70.0±23 mm。平均开孔数为2.1±1个(33.3%为3-FEN或4-FEN)。最常见的桥架支架是iCover (n=15, 40.5%)、BeGraft (n=10, 27.0%)和VBX (n=9, 24.3%)。平均植入时间198.9±90分钟。除一例(n= 17,94%)外,所有病例均取得技术成功,无30天死亡率,无再干预,中位随访10个月时靶血管通畅100%。3例(16.7%)患者死于非主动脉相关原因。在计算机断层扫描对照中发现了1例残留的IA型内漏,根据患者的决定不予治疗。结论:采用美敦力endant内植体的PMEG,在二维模板和3d打印确认模型的支持下,为复杂的、不可延迟的AAA修复提供了安全有效的短期效果。采用标准化方案的PMEG的长期数据和前瞻性研究将为这项技术提供证据,促进与定制和现成设备的充分比较。临床影响:这篇简短的系列文章重点介绍了使用美敦力endurance平台的医师改良内移植物(PMEG)的初步结果。所有耐用尺寸的专用2D模板作为补充材料提供,为血管社区的从业者提供宝贵的帮助。基于这些模板的标准化修改方案以及无菌3d打印模型的双重检查,可以实现令人满意的短期结果。这些结果与定制设备相当,即使在需要非延期修复和涉及具有挑战性的解剖限制的情况下,如1A型内漏。
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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