Jean Sénémaud, Jennifer Canonge, Joseph Touma, Adrien Glomaud, Marek Majewski, Vania Tacher, Hicham Kobeiter, Pascal Desgranges
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Midterm outcomes were estimated using the Kaplan-Meier time to event method and 95% confidence intervals (95% CI).</p><p><strong>Results: </strong>Sixty patients underwent LEVAR procedures during the study period. All patients were deemed unfit for open repair. The LEVAR cases included 12 symptomatic aneurysms, 33 enlarging aneurysms > 65 mm, 14 anatomical constraints and/or presence of previous renal stents, and one rupture. The median diameter of aortic aneurysms was 65.5 mm (IQR 13). One hundred seventy antegrade laser fenestrations were performed (mean 2.8/patient). IOAEs were recorded in 21 cases (35%). Technical success was recorded in 98% of cases. The in hospital mortality rate was 5% (n = 3). The median follow up duration was 35.7 months. The estimates of overall survival and freedom from re-intervention at three years were 81% (95% CI 68.3 - 89) and 60.2% (95% CI 43.4 - 73.4), respectively. Six target vessels occluded during follow up, giving a three year target vessel patency rate of 90.1% (95% CI 77.5 - 95.8). Two LEVAR explantations were recorded during follow up, either for infection or persistent endoleak. The three year freedom from aortic death estimate was 98% (95% CI 86.9 - 99.7).</p><p><strong>Conclusion: </strong>In high risk patients deemed unfit for open repair, LEVAR may provide satisfactory midterm overall survival and target vessel patency rates, although re-intervention rates were high in this study, requiring close and extensive follow up.</p>","PeriodicalId":55160,"journal":{"name":"European Journal of Vascular and Endovascular Surgery","volume":" ","pages":""},"PeriodicalIF":5.7000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Midterm Results of Antegrade Laser Fenestrations Using Image Fusion Guidance in Complex Aortic Aneurysm Repair.\",\"authors\":\"Jean Sénémaud, Jennifer Canonge, Joseph Touma, Adrien Glomaud, Marek Majewski, Vania Tacher, Hicham Kobeiter, Pascal Desgranges\",\"doi\":\"10.1016/j.ejvs.2025.04.071\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This retrospective, observational, single centre study aimed to describe midterm results of physician modified stent grafts using antegrade laser fenestrations and image fusion guidance (LEVAR) for the treatment of complex abdominal aortic aneurysms, thoraco-abdominal aortic aneurysms, and type I endoleaks.</p><p><strong>Methods: </strong>All LEVAR procedures between 1 September 2016 and 1 January 2022 were reviewed. Endpoints included intra-operative adverse events (IOAEs), in hospital mortality, re-interventions, and target vessel patency. Midterm outcomes were estimated using the Kaplan-Meier time to event method and 95% confidence intervals (95% CI).</p><p><strong>Results: </strong>Sixty patients underwent LEVAR procedures during the study period. All patients were deemed unfit for open repair. The LEVAR cases included 12 symptomatic aneurysms, 33 enlarging aneurysms > 65 mm, 14 anatomical constraints and/or presence of previous renal stents, and one rupture. The median diameter of aortic aneurysms was 65.5 mm (IQR 13). One hundred seventy antegrade laser fenestrations were performed (mean 2.8/patient). IOAEs were recorded in 21 cases (35%). Technical success was recorded in 98% of cases. The in hospital mortality rate was 5% (n = 3). The median follow up duration was 35.7 months. The estimates of overall survival and freedom from re-intervention at three years were 81% (95% CI 68.3 - 89) and 60.2% (95% CI 43.4 - 73.4), respectively. Six target vessels occluded during follow up, giving a three year target vessel patency rate of 90.1% (95% CI 77.5 - 95.8). Two LEVAR explantations were recorded during follow up, either for infection or persistent endoleak. The three year freedom from aortic death estimate was 98% (95% CI 86.9 - 99.7).</p><p><strong>Conclusion: </strong>In high risk patients deemed unfit for open repair, LEVAR may provide satisfactory midterm overall survival and target vessel patency rates, although re-intervention rates were high in this study, requiring close and extensive follow up.</p>\",\"PeriodicalId\":55160,\"journal\":{\"name\":\"European Journal of Vascular and Endovascular Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.7000,\"publicationDate\":\"2025-05-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Vascular and Endovascular Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ejvs.2025.04.071\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Vascular and Endovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ejvs.2025.04.071","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
摘要
目的：这项回顾性、观察性、单中心研究旨在描述医师改良支架移植采用顺行激光开窗和图像融合引导（LEVAR）治疗复杂腹主动脉瘤、胸腹主动脉瘤和I型内漏的中期结果。方法：回顾2016年9月1日至2022年1月1日期间所有LEVAR手术。终点包括术中不良事件（ioae）、住院死亡率、再干预和靶血管通畅。中期结果采用Kaplan-Meier时间-事件法和95%置信区间（95% CI）估计。结果：60例患者在研究期间接受了LEVAR手术。所有患者均被认为不适合开放式修复。LEVAR病例包括12例有症状的动脉瘤，33例动脉瘤扩大至1065mm， 14例解剖约束和/或存在既往肾支架，1例破裂。主动脉瘤中位直径65.5 mm （IQR 13）。170例行顺行激光开窗术（平均2.8例/例）。21例（35%）发生ioae。98%的病例技术成功。住院死亡率为5% （n = 3）。中位随访时间为35.7个月。3年的总生存率和再次干预自由度分别为81% （95% CI 68.3 - 89）和60.2% （95% CI 43.4 - 73.4）。随访期间有6条靶血管闭塞，三年内靶血管通畅率为90.1% （95% CI 77.5 - 95.8）。随访期间记录了2例LEVAR解释，要么是感染，要么是持续性内漏。三年无主动脉死亡估计为98% （95% CI 86.9 - 99.7）。结论：在被认为不适合开放修复的高危患者中，LEVAR可以提供令人满意的中期总生存率和靶血管通畅率，尽管本研究中的再干预率很高，需要密切和广泛的随访。
Midterm Results of Antegrade Laser Fenestrations Using Image Fusion Guidance in Complex Aortic Aneurysm Repair.
Objective: This retrospective, observational, single centre study aimed to describe midterm results of physician modified stent grafts using antegrade laser fenestrations and image fusion guidance (LEVAR) for the treatment of complex abdominal aortic aneurysms, thoraco-abdominal aortic aneurysms, and type I endoleaks.
Methods: All LEVAR procedures between 1 September 2016 and 1 January 2022 were reviewed. Endpoints included intra-operative adverse events (IOAEs), in hospital mortality, re-interventions, and target vessel patency. Midterm outcomes were estimated using the Kaplan-Meier time to event method and 95% confidence intervals (95% CI).
Results: Sixty patients underwent LEVAR procedures during the study period. All patients were deemed unfit for open repair. The LEVAR cases included 12 symptomatic aneurysms, 33 enlarging aneurysms > 65 mm, 14 anatomical constraints and/or presence of previous renal stents, and one rupture. The median diameter of aortic aneurysms was 65.5 mm (IQR 13). One hundred seventy antegrade laser fenestrations were performed (mean 2.8/patient). IOAEs were recorded in 21 cases (35%). Technical success was recorded in 98% of cases. The in hospital mortality rate was 5% (n = 3). The median follow up duration was 35.7 months. The estimates of overall survival and freedom from re-intervention at three years were 81% (95% CI 68.3 - 89) and 60.2% (95% CI 43.4 - 73.4), respectively. Six target vessels occluded during follow up, giving a three year target vessel patency rate of 90.1% (95% CI 77.5 - 95.8). Two LEVAR explantations were recorded during follow up, either for infection or persistent endoleak. The three year freedom from aortic death estimate was 98% (95% CI 86.9 - 99.7).
Conclusion: In high risk patients deemed unfit for open repair, LEVAR may provide satisfactory midterm overall survival and target vessel patency rates, although re-intervention rates were high in this study, requiring close and extensive follow up.
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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