Long-term Comparison of Physician-Modified Endografts With and Without Low-Profile Fabric Designs for Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms.
Armin Tabiei, Jesse Chait, Randall R DeMartino, Gustavo S Oderich, Sukgu M Han, Bernardo C Mendes
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引用次数: 0
Abstract
Objective: Following commercial approval, our institution began utilizing the Cook Zenith Alpha low-profile stent graft (LPSG) for physician-modified endograft (PMEG) repair of complex abdominal (CAAA) and thoracoabdominal aortic aneurysms (TAAA) due to its smaller sheath size and wider apex-to-apex stent distances, allowing for better accommodation of modifications. We aimed to compare outcomes of PMEGs using LPSGs and the standard-profile stent graft (SPSG), Zenith TX2.
Methods: We reviewed clinical data and outcomes of patients treated using PMEGs for CAAAs (short-neck infrarenal, juxtarenal, and pararenal AAAs) and TAAAs between 2007-2024. Endpoints included 30-day mortality and major adverse events (MAEs), patient survival, freedom from reintervention, freedom from target artery (TA) instability and freedom from type III endoleak.
Results: Of 317 patients treated with PMEGs, 228 (72%) were men with a mean age of 74 ± 9 years. SPSGs were utilized in 174 (55%) patients and LPSGs were utilized in 143 (45%) patients. Patients treated with LPSGs were mostly treated for TAAAs (69% vs 48%) and subsequently had more incorporated TAs per patient (3.7 ± 0.6 vs 3.1 ± 1.0) compared to the SPSG cohort (p=<.001). LPSGs had been used more frequently with percutaneous femoral access (91% vs 36%, p=<.001) and less frequently with upper extremity access (41% vs 75%, p=<.001), and iliofemoral conduits (6% vs 21%, p=<.001). Technical success rates were similar between the two groups (89%; LPSG vs 93%; SPSG, p=<.001), with shorter operating time (257 ± 89 minutes vs 296 ± 107 minutes), and lower estimated blood loss (383 ± 464 mL vs 1063 ± 1221 mL) compared to the SPSG cohort (p=<.001). Early (30-day) mortality (5%; SPSG vs 4% LPSG) and any MAE rates (30; SPSG vs 23; LPSG) were similar between two groups, however, patients in the SPSG cohort were more likely to undergo early aortic or side-branch related reintervention (13% vs 6%, p=<.035). There were no significant differences in four-year overall survival, freedom from TA instability, freedom from reintervention and freedom from type III endoleak rates between the two groups.
Conclusion: Repair of CAAAs and TAAAs with PMEGs utilizing devices with low-profile fabric has similar perioperative and long-term outcomes compared to standard-profile endografts including no difference in endoleak or issues with device integrity. Confounding factors in this comparison include learning curve, improved surveillance, and treatment of more complex aneurysms.
目的：在获得商业批准后，我们的机构开始使用Cook Zenith Alpha低轮廓支架（LPSG）用于复杂腹部（CAAA）和胸腹主动脉瘤（TAAA）的医生改良内移植术（PMEG）修复，因为它的鞘尺寸更小，支架间距更宽，可以更好地适应改良。我们的目的是比较使用LPSGs和标准支架移植（SPSG） Zenith TX2的PMEGs的结果。方法：我们回顾了2007-2024年间使用PMEGs治疗CAAAs（短颈肾下、肾旁和肾旁AAAs）和TAAAs的患者的临床数据和结果。终点包括30天死亡率和主要不良事件（MAEs）、患者生存、免于再干预、免于靶动脉（TA）不稳定和免于III型内漏。结果：317例接受pmeg治疗的患者中，228例（72%）为男性，平均年龄74±9岁。174例（55%）患者使用了spgs， 143例（45%）患者使用了LPSGs。与SPSG队列相比，lpsg治疗的患者大多接受TAAAs治疗（69% vs 48%），随后每位患者合并的TAAAs更多（3.7±0.6 vs 3.1±1.0）(p=结论：与标准内移植物相比，使用低结构装置的pmeg修复CAAAs和TAAAs具有相似的围手术期和长期结果，包括内漏或装置完整性问题没有差异。这种比较的混杂因素包括学习曲线、改进的监测和更复杂的动脉瘤的治疗。
期刊介绍：
Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.
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