{"title":"血管内治疗肾下动脉瘤后,近端固定对动脉瘤颈演变的影响。","authors":"","doi":"10.1016/j.avsg.2024.07.092","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>We analyzed the long-term influence of fixation systems on proximal aortic neck (PAN) evolution by comparing 2 late-generation endoprostheses, Endurant (Medtronic Vascular, Minneapolis, Minn) with suprarenal fixation (SRF) and Excluder (W.L Gore & Associates, Flagstaff, Ariz) with infrarenal fixation (IRF).</p></div><div><h3>Methods</h3><p>Our retrospective observational study included consecutive patients undergoing endovascular aneurysm repair (EVAR) for aorto-iliac aneurysms (2011–2020). Primary end points: neck enlargement and freedom from significative PAN enlargement (5 mm). Secondary end points: neck-related reintervention, endoleaks and graft migration. Results were reported following the Society of Vascular Surgery reporting standards.</p></div><div><h3>Results</h3><p>139 patients were included (97 in SRF group and 42 in IRF group). A difference in growth at 10 mm caudal to lowest renal artery at 2 years follow-up was found (mean growth of 1.92 ± 3.38 mm in SRF and 0.16 ± 6.86 mm in IRF; <em>P</em> < 0.001). A tendency to a major growth in SRF at 4 years follow-up at the lowest renal artery (1.27 ± 3.36 mm vs. 0.63 ± 2.2 mm; <em>P</em> = 0.06), 5 mm distal to lowest renal artery (2.17 ± 3.52 mm vs. 0.94 ± 2.76 mm; <em>P</em> = 0.001) and 10 mm distal to lowest renal artery (2.65 ± 3.86 mm vs. 1.12 ± 1.5 mm; <em>P</em> < 0.001) was shown. Freedom from PAN enlargement was 96.65% and 88.20% in SRF and 100% and 94.4% in IRF at 2 and 4 years follow-up respectively (log rank 0.041). A greater incidence of type II endoleaks in IRF was observed (40.48% vs. 15.46%; <em>P</em> = 0.001). Oversizing >15% showed to be a risk factor of PAN enlargement (odds ratio 6.85; 95% confident interval: 1.67–28.4; <em>P</em> = 0.007).</p></div><div><h3>Conclusions</h3><p>A small but significative percentage of patients after EVAR show a progressive PAN enlargement, being significatively greater in SRF, without increasing neck-related complications 4 years after graft deployment.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Influence of Proximal Fixation on Aneurysm Neck Evolution after Endovascular Treatment of Infrarenal Aneurysms\",\"authors\":\"\",\"doi\":\"10.1016/j.avsg.2024.07.092\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>We analyzed the long-term influence of fixation systems on proximal aortic neck (PAN) evolution by comparing 2 late-generation endoprostheses, Endurant (Medtronic Vascular, Minneapolis, Minn) with suprarenal fixation (SRF) and Excluder (W.L Gore & Associates, Flagstaff, Ariz) with infrarenal fixation (IRF).</p></div><div><h3>Methods</h3><p>Our retrospective observational study included consecutive patients undergoing endovascular aneurysm repair (EVAR) for aorto-iliac aneurysms (2011–2020). Primary end points: neck enlargement and freedom from significative PAN enlargement (5 mm). Secondary end points: neck-related reintervention, endoleaks and graft migration. Results were reported following the Society of Vascular Surgery reporting standards.</p></div><div><h3>Results</h3><p>139 patients were included (97 in SRF group and 42 in IRF group). A difference in growth at 10 mm caudal to lowest renal artery at 2 years follow-up was found (mean growth of 1.92 ± 3.38 mm in SRF and 0.16 ± 6.86 mm in IRF; <em>P</em> < 0.001). A tendency to a major growth in SRF at 4 years follow-up at the lowest renal artery (1.27 ± 3.36 mm vs. 0.63 ± 2.2 mm; <em>P</em> = 0.06), 5 mm distal to lowest renal artery (2.17 ± 3.52 mm vs. 0.94 ± 2.76 mm; <em>P</em> = 0.001) and 10 mm distal to lowest renal artery (2.65 ± 3.86 mm vs. 1.12 ± 1.5 mm; <em>P</em> < 0.001) was shown. Freedom from PAN enlargement was 96.65% and 88.20% in SRF and 100% and 94.4% in IRF at 2 and 4 years follow-up respectively (log rank 0.041). A greater incidence of type II endoleaks in IRF was observed (40.48% vs. 15.46%; <em>P</em> = 0.001). Oversizing >15% showed to be a risk factor of PAN enlargement (odds ratio 6.85; 95% confident interval: 1.67–28.4; <em>P</em> = 0.007).</p></div><div><h3>Conclusions</h3><p>A small but significative percentage of patients after EVAR show a progressive PAN enlargement, being significatively greater in SRF, without increasing neck-related complications 4 years after graft deployment.</p></div>\",\"PeriodicalId\":8061,\"journal\":{\"name\":\"Annals of vascular surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-08-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of vascular surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0890509624004898\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0890509624004898","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
目的:我们通过比较两种晚期主动脉内膜假体,即采用肾上固定(SRF)的 Endurant(美敦力血管公司,明尼阿波利斯)和采用肾下固定(IRF)的 Excluder(W.L Gore & Associates,弗拉格斯塔夫,亚利桑那州),分析了固定系统对近端主动脉颈(PAN)演变的长期影响:我们的回顾性观察研究包括连续接受髂主动脉瘤 EVAR 手术的患者(2011-2020 年)。主要终点:颈部扩大和无明显 PAN 扩大(5 毫米)。次要终点:颈部相关的再介入、内漏和移植物移位。结果按照血管外科学会的报告标准进行报告:结果:共纳入 139 例患者(SRF 组 97 例,IRF 组 42 例)。随访 2 年时,发现最低肾动脉尾端 10 mm 处的生长情况存在差异(SRF 组平均生长 1.92 ± 3.38 mm,IRF 组平均生长 0.16 ± 6.86 mm;P 15%),表明这是 PAN 扩大的风险因素(OR 6.85;95% IC 1.67 - 28.4;P =.007):结论:EVAR术后有一小部分患者的PAN逐渐增大,SRF显著增大,但移植物植入四年后颈部相关并发症并未增加。
Influence of Proximal Fixation on Aneurysm Neck Evolution after Endovascular Treatment of Infrarenal Aneurysms
Background
We analyzed the long-term influence of fixation systems on proximal aortic neck (PAN) evolution by comparing 2 late-generation endoprostheses, Endurant (Medtronic Vascular, Minneapolis, Minn) with suprarenal fixation (SRF) and Excluder (W.L Gore & Associates, Flagstaff, Ariz) with infrarenal fixation (IRF).
Methods
Our retrospective observational study included consecutive patients undergoing endovascular aneurysm repair (EVAR) for aorto-iliac aneurysms (2011–2020). Primary end points: neck enlargement and freedom from significative PAN enlargement (5 mm). Secondary end points: neck-related reintervention, endoleaks and graft migration. Results were reported following the Society of Vascular Surgery reporting standards.
Results
139 patients were included (97 in SRF group and 42 in IRF group). A difference in growth at 10 mm caudal to lowest renal artery at 2 years follow-up was found (mean growth of 1.92 ± 3.38 mm in SRF and 0.16 ± 6.86 mm in IRF; P < 0.001). A tendency to a major growth in SRF at 4 years follow-up at the lowest renal artery (1.27 ± 3.36 mm vs. 0.63 ± 2.2 mm; P = 0.06), 5 mm distal to lowest renal artery (2.17 ± 3.52 mm vs. 0.94 ± 2.76 mm; P = 0.001) and 10 mm distal to lowest renal artery (2.65 ± 3.86 mm vs. 1.12 ± 1.5 mm; P < 0.001) was shown. Freedom from PAN enlargement was 96.65% and 88.20% in SRF and 100% and 94.4% in IRF at 2 and 4 years follow-up respectively (log rank 0.041). A greater incidence of type II endoleaks in IRF was observed (40.48% vs. 15.46%; P = 0.001). Oversizing >15% showed to be a risk factor of PAN enlargement (odds ratio 6.85; 95% confident interval: 1.67–28.4; P = 0.007).
Conclusions
A small but significative percentage of patients after EVAR show a progressive PAN enlargement, being significatively greater in SRF, without increasing neck-related complications 4 years after graft deployment.
期刊介绍:
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence