经血管内动脉瘤密封（EVAS）和血管内动脉瘤修复（EVAR）治疗的腹主动脉瘤的长期随访：单中心回顾性队列

IF 1.4 Q3 PERIPHERAL VASCULAR DISEASE

EJVES Vascular Forum Pub Date : 2025-01-01 DOI:10.1016/j.ejvsvf.2025.05.003

Simen Tveten Berge , Konstantin Valerievitch Naletov , Sven Ross Mathisen

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引用次数: 0

摘要

目的Nellix血管内动脉瘤密封（EVAS）系统自2011年推出以来，显示出良好的短期和中期疗效。然而，长期结果显示移植物衰竭的发生率很高。本研究旨在比较EVAS与标准血管内动脉瘤修复（EVAR）的长期结果。方法本研究采用挪威Hamar医院innlanddet医院信托内部质量控制登记处的前瞻性注册数据，采用单中心、回顾性、比较队列分析。2013 - 2016年间，231例患者接受了主动脉-髂动脉瘤疾病的选择性血管内修复。主要选择性EVAR （n = 164）与主要选择性EVAS （n = 117）进行比较。结果EVAR和EVAS的技术成功率为100%。EVAS患者住院时间较短(3.7天vs. 4.7天；p = 0.008)，术后C反应蛋白（CRP）水平较低(p <；0.001)。30天（p = 0.79）、1年（p = 0.97）或长期全因死亡率均无统计学差异，中位随访时间为9.3年（p = 0.93）。在长期随访中，II型内漏在EVAS患者中明显较少见(2.6% vs. 32.3%；p & lt;0.001)。然而，EVAS的设备耐久性较低，五年内设备无故障率为54%，而EVAR为98% (p <；0.001)。31%的EVAS患者和2.4%的EVAR患者需要进行开放手术转换(p <；0.001)。动脉瘤囊≥5mm的EVAS病例占47%，EVAR病例占17.1% (p <；0.001)。结论：虽然EVAS和EVAR的长期全因死亡率相当，但EVAS与移植失败、动脉瘤囊生长、动脉瘤相关死亡和开放手术转换的发生率有统计学意义上的显著升高。在登记处密切监测新的假体装置对于识别设备故障的早期迹象至关重要。

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Long Term Follow Up of Abdominal Aortic Aneurysms Treated With Endovascular Aneurysm Sealing (EVAS) and Endovascular Aneurysm Repair (EVAR): A Single Centre Retrospective Cohort

Objective

The Nellix endovascular aneurysm sealing (EVAS) system demonstrated promising short and midterm outcomes following its introduction in 2011. However, long term results have shown a high incidence of graft failure. This study aimed to compare the long term outcomes of EVAS compared with standard endovascular aneurysm repair (EVAR).

Methods

This single centre, retrospective, comparative cohort analysis used prospectively registered data from an internal quality control registry at Innlandet Hospital Trust, Hamar Hospital, Norway. Two hundred and eighty-one patients underwent elective endovascular repair for aorto-iliac aneurysm disease between 2013 – 2016. Primary elective EVAR (n = 164) was compared with primary elective EVAS (n = 117).

Results

Technical success was achieved in 100% of the EVAR and EVAS cases. The EVAS patients had a shorter hospital stay (3.7 vs. 4.7 days; p = 0.008), and lower post-procedural C reactive protein (CRP) levels (p < 0.001). No statistically significant differences were found in 30 day (p = 0.79), one year (p = 0.97), or long term all cause mortality rates, with a median follow up of 9.3 years (p = 0.93). During long term follow up, type II endoleaks were significantly less common in EVAS patients (2.6% vs. 32.3%; p < 0.001). However, EVAS had lower device durability, with freedom from device failure at five years of 54% compared with 98% for EVAR (p < 0.001). Open surgical conversion was required in 31% of EVAS patients and 2.4% of EVAR patients (p < 0.001). Aneurysm sac growth ≥5 mm was recorded in 47% of EVAS cases compared with 17.1% of EVAR cases (p < 0.001).

Conclusion

While long term all cause mortality was comparable between EVAS and EVAR, EVAS was associated with statistically significantly higher rates of graft failure, aneurysm sac growth, aneurysm related death, and open surgical conversion. Close monitoring of new prosthetic devices in registries is essential to identify early signs of device failure.

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来源期刊

EJVES Vascular Forum Medicine-Surgery

CiteScore

1.50

自引率

0.00%

发文量

145

审稿时长

102 days