针对复杂主动脉疾病的医生改良瓣膜或平行内植物的单中心评估。

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Journal of Endovascular Therapy Pub Date : 2024-10-01 Epub Date: 2023-01-16 DOI:10.1177/15266028221149918
Siting Li, Wei Wang, Xiaoning Sun, Zhili Liu, Rong Zeng, Jiang Shao, Bao Liu, Yuexin Chen, Wei Ye, Yuehong Zheng
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引用次数: 0

摘要

目的:本研究旨在调查复杂主动脉疾病血管内修复的栅栏技术和平行技术的人口统计学和解剖学特征以及围手术期和随访结果:一项回顾性研究对2013年至2021年期间在一家研究所接受血管内治疗的67例连续性复杂主动脉疾病患者进行了研究,这些疾病包括腹主动脉瘤(AAA)、胸腹动脉瘤(TAAA)、主动脉夹层,或之前接受过血管内修复术的患者。介入治疗的选择取决于疾病的紧急程度、患者的一般状况、解剖学特征以及设备指南的建议。对患者的临床人口统计学特征、主动脉疾病特征、围手术期细节和疾病进程进行了讨论。获得并分析了短期和中期随访结果。终点是动脉瘤相关和非相关死亡率、分支不稳定性和肾功能恶化:结果:分别有34名和27名患者接受了f-EVAR和ch-EVAR手术,6名患者接受了这两种手术的组合。瓣膜内主动脉修补术主要用于影响内脏分支的 AAA 和 TAAA,而 ch-EVAR 通常用于肾下 AAA。关于每名患者平均重建动脉的数量,f-EVAR、ch-EVAR 和联合组之间存在显著差异(平均值 = 2.3 ± 0.9、1.4 ± 0.6、3.5 ± 0.5,p):总之,本研究表明,f-EVAR 和 ch-EVAR 技术的围手术期和随访结果均可接受,在遇到复杂的主动脉疾病时,应将其视为可行的替代方案:临床影响:本研究旨在调查一家中国医疗机构中f-EVAR和ch-EVAR的基线和病理特征,以及围手术期和随访结果。F-EVAR(主要是医生改良的f-EVAR)适用于各种病因和疾病类型的患者,而ch-EVAR则首选用于年龄较大、ASA分级平均较高的AAA患者。我们的经验表明,这两种技术的安全性和有效性都是可以接受的,两组患者在中短期不良反应方面没有明显差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Monocentric Evaluation of Physician-Modified Fenestrations or Parallel Endografts for Complex Aortic Diseases.

Purpose: This study aimed to investigate the demographic and anatomic characteristics, as well as perioperative and follow-up results of fenestration and parallel techniques for the endovascular repair of complex aortic diseases.

Materials and methods: A retrospective study was conducted on 67 consecutive patients underwent endovascular treatment for complex aortic diseases including abdominal aortic aneurysm (AAA), thoracoabdominal aneurysm (TAAA), aortic dissection, or prior endovascular repair with either fenestrated and parallel endovascular aortic repair (f-EVAR or ch-EVAR) at a single institute from 2013 to 2021. Choices of intervention were made by the disease' emergency, patients' general condition, the anatomic characteristics, as well as following the recommendation from the devices' guidelines. Patients' clinical demographics, aortic disease characteristics, perioperative details, and disease courses were discussed. Short- and mid-term follow-up results were obtained and analyzed. Endpoints were aneurysm-related and unrelated mortality, branch instability, and renal function deterioration.

Results: Totally, 34 and 27 patients received f-EVAR and ch-EVAR, while 6 patients received a combination of both. Fenestrated endovascular aortic repair was conducted mainly in AAA affecting visceral branches and TAAA, whereas ch-EVAR was normally utilized for infrarenal AAA. Regarding the average number of reconstructed arteries per patient, there was a significant difference among f-EVAR, ch-EVAR, and the combination group (mean = 2.3 ± 0.9, 1.4 ± 0.6, 3.5 ± 0.5, p<0.001). Primary technical success was achieved in 28 (82.4%), 22 (81.5%), and 3 (50.0%) patients for each group. Besides operational time (5.77 ± 2.58, 4.47 ± 1.44, p=0.033), no significant difference was observed for blood transfusion, intensive care unit (ICU) or hospital stay, blood creatinine level, 30-day complications, or follow-up complications between patients undergoing f-EVAR or ch-EVAR. Patients receiving combination of both techniques had a higher rate of blood transfusion (p=0.044), longer operational time (p=0.008) or hospital stay (p=0.017), as well as more stent occlusion (p=0.001), endoleak (p=0.004) at short-term and a higher rate of endoleak (p=0.023) at mid-term follow-up.

Conclusion: In conclusion, this study demonstrated that f-EVAR and ch-EVAR techniques had acceptable perioperative and follow-up results and should be considered viable alternatives when encountering complex aortic diseases.

Clinical impact: This study sought to investigate the baseline and pathological characteristics, as well as perioperative and follow-up results of f-EVAR and ch-EVAR at a single Chinese institution. F-EVAR (mostly physician-modified f-EVAR) was applied in patients with a wide range of etiologies and disease types, while ch-EVAR was preferred for AAA in older patients with an average higher ASA grade. Our experience suggested acceptable safety and efficacy both for techniques, and no significant difference was observed between the two groups regarding any short or mid-term adverse events.

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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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