髂弯曲指数对开窗肾旁和胸腹主动脉瘤腔内修复的影响。

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Journal of Endovascular Therapy Pub Date : 2025-04-01 Epub Date: 2023-05-08 DOI:10.1177/15266028231172375
Lia Jordano, Emilie C Robinson, Aleem Mirza, Nedaa Skeik, Larissa Stanberry, Jesse Manunga
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引用次数: 0

摘要

目的:评价髂曲度对复杂主动脉瘤(cAAs)行开窗/支状内植修复术(f/b-EVAR [endovascular aortic动脉瘤修复术])的手术指标和预后的影响。材料和方法:该研究是一项单中心、回顾性的研究,对2013年至2020年在我们机构使用f/b-EVAR进行动脉瘤修复的患者的前瞻性数据库进行了回顾。纳入的患者术前至少有1次计算机断层血管造影(CTA)可用于分析。利用三维工作站血流成像中心线,根据公式(中心线髂动脉长度/直线髂动脉长度)计算髂动脉弯曲指数(TI)。髂动脉扭曲与手术指标之间的关系,包括总手术时间、透视时间、放射剂量、造影剂体积和估计失血量(EBL)。结果:在此期间,219例cAAs患者在我院接受了f/b-EVAR。91例患者(74%男性;平均年龄= 75.2±7.7岁)符合纳入研究的标准。本组有肾旁或内脏旁动脉瘤72例(79%),胸腹主动脉瘤18例(20%),既往EVAR失败5例(5.4%)。动脉瘤平均直径为60.1±0.74 mm。总的来说,270条血管被靶向,267条(99%)血管成功合并,包括25条腹腔动脉,67条肠系膜上动脉和175条肾动脉。平均总手术时间236±83分钟,透视时间87±39分钟,造影剂体积81±47 mL,放射剂量3246±2207 mGy, EBL 290±409 mL。所有患者的平均左、右ti分别为1.5±0.3和1.4±0.3。在多变量分析中,区间估计表明TI与程序指标之间存在一定程度的正相关关系。结论:在目前的系列研究中,我们发现髂动脉TI与使用f/b-EVAR进行cAA修复的患者的手术时间、造影剂、EBL、透视时间和剂量等程序性指标之间没有明确的关联。然而,在多变量分析中,TI和所有这些指标之间存在关联的趋势。这种潜在的关联需要在更大的序列中进行评估。临床影响:髂动脉弯曲不应排除复杂主动脉瘤患者的开窗或分支支架修复。然而,对于动脉大到足以容纳这种鞘的患者,应特别考虑减轻通路扭曲对开窗与靶血管对齐的影响,包括使用额外的硬丝,穿过和穿过通路,并将开窗/分支装置送入另一个(更大的)鞘中,如Gore DrySeal。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effects of Iliac Tortuosity Index on Fenestrated Endovascular Aortic Aneurysm Repair for Pararenal and Thoracoabdominal Aortic Aneurysms.

Purpose: To evaluate the effect of iliac tortuosity on procedural metrics and outcomes of patients with complex aortic aneurysms (cAAs) undergoing repair with fenestrated/branched endografts (f/b-EVAR [endovascular aortic aneurysm repair]).

Material and methods: The study is a single-center, retrospective review of a prospectively maintained database of patients undergoing aneurysm repair using f/b-EVAR between the years 2013 and 2020 at our institution. Included patients had at least 1 preoperative computed tomography angiography (CTA) available for analysis. Iliac artery tortuosity index (TI) was calculated using centerline of flow imaging from a 3-dimensional work station based on the formula: (centerline iliac artery length / straight-line iliac artery length). The associations between iliac artery tortuosity and procedural metrics, including total operative time, fluoroscopy time, radiation dose, contrast volume, and estimated blood loss (EBL), were evaluated.

Results: During this period, 219 patients with cAAs underwent f/b-EVAR at our institution. Ninety-one patients (74% men; mean age = 75.2±7.7 years) met criteria for inclusion into the study. In this group, there were 72 (79%) juxtarenal or paravisceral aneurysms and 18 (20%) thoracoabdominal aortic aneurysms and 5 patients (5.4%) with failed previous EVAR. The average aneurysm diameter was 60.1±0.74 mm. Overall, 270 vessels were targeted, and 267 (99%) were successfully incorporated, including 25 celiac arteries, 67 superior mesenteric arteries, and 175 renal arteries. The mean total operative time was 236±83 minutes, fluoroscopy time was 87±39 minutes, contrast volume was 81±47 mL, radiation dose 3246±2207 mGy, and EBL was 290±409 mL. The average left and right TIs for all patients were 1.5±0.3 and 1.4±0.3, respectively. On multivariable analysis, the interval estimates suggest positive association between TI and procedural metrics to a certain degree.

Conclusions: In the current series, we found no definitive association between iliac artery TI and procedural metrics, including operative time, contrast used, EBL, fluoroscopy time, and dose in patients undergoing cAA repair using f/b-EVAR. However, there was a trend toward association between TI and all these metrics on multivariable analysis. This potential association needs to be evaluated in a larger series.Clinical ImpactIliac artery tortuosity should not exclude patients with complex aortic aneurysms from being offered fenestrated or branched stent graft repair. However, special considerations should be taken to mitigate the impact of access tortuosity on alignment of fenestrations with target vessels, including use of extra stiff wires, through and through access and delivering the fenestrated/branched device into another (larger) sheath such as a Gore DrySeal in patients with arteries large enough to accommodate such sheaths.

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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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