Incraft覆膜支架治疗复杂瘤颈腹主动脉瘤单中心应用经验  

Endovascular aortic repair of complex abdominal aorta aneurysm with Incraft endograft system:a single center experience

作　　者：韩晓峰[1] 刘光锐[1] 李铁铮[1] 马晓海[1] 郭曦[1] Han Xiaofeng;Liu Guangrui;Li Tiezheng;Ma Xiaohail;Guo Xi(Department of Diagnostic and Interventional Radiology,Bejing Anzhen Hospital,Capital Medical University,Bejing 00029 China)

机构地区：[1]首都医科大学附属北京安贞医院介入诊疗科,北京100029

出　　处：《中华胸心血管外科杂志》2024年第5期277-283,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的评价Incraft覆膜支架应用于复杂瘤颈腹主动脉瘤腔内治疗的临床效果。方法回顾性分析北京安贞医院2019年9月至2022年9月应用Incraft覆膜支架腔内治疗腹主动脉瘤患者的临床资料,根据患者瘤颈条件分为复杂瘤颈组(13例)和正常瘤颈组(50例)。早期终点事件为术中非计划性补救cuff支架和栓塞弹簧圈、30天的发病率和死亡比例以及再干预事件。随访期终点事件为内漏、支架移位、髂支和/或分支支架狭窄或闭塞以及再干预事件发生,对比两组患者的内漏、瘤腔回缩、分支/髂支支架通畅性以及免于再干预情况。结果入组63例患者均顺利完成手术。对比正常瘤颈组患者,复杂瘤颈组患者具有更短的瘤颈长度[(9.9±8.3)mm对(29.6±12.3)mm,P<0.001]、更大的瘤颈角度[(39.1±30.4)°对(25.1±15.4)°,P=0.036]和更大的最大瘤腔直径[(57.5±13.4)mm对(45.5±12.4)mm,P=0.016]。两组患者的围术期主体支架放大率、内漏发生率及住院天数差异无统计学意义,但复杂瘤颈组患者需要更多的手术时间[(96.36±31.83)min对(63.58±26.68)min,P=0.001]。3年期随访(中位时间18个月)发现两组患者在内漏和支架相关并发症发生以及再干预方面差异有统计学意义。结论Incraft覆膜支架在治疗包括复杂瘤颈在内的肾下型腹主动脉瘤具有良好的近中期安全性和有效性,长期效果有待进一步观察。Objective To report a single-center experience with the Cordis Incraft endograft with low-profile in abdominal aortic aneurysms(AAAs)with severe infrarenal neck.Methods All patients underwent EVAR with Incraft stent grafts between September 2019 and September 2022,were prospectively enrolled,and retrospectively analyzed.Anatomical details of the proximal aortic neck were evaluated,divided into the severe infrarenal neck(SIN,13 cases)and normal infrarenal neck(NIN,50 cases)groups.Early endpoints were intraoperative unplanned cuff or coil embolism,technical success(TS),30-day morbidity/mortality,and reinterventions.Follow-up endpoints were occurrence of endoleaks,endograft migration,branch stent/iliac stent-graft stenosis or occlusion,reintervention.The postoperative endoleak,aneurysm sac shrinkage,patency of iliac stent-graft/branch stent,and freedom from reinterventions between the two groups were compared.Results A total of sixty-three patients were enrolled in this trial,all of whom were successfully treated.There was no significant difference in patient and lesion characteristics,excluding aneurysm neck length,neck angle and maximum aneurysm sac diameter.Proximal aneurysm neck length was shorter in the SIN group[(9.9±8.3)mm vs.(29.6±12.3)mm,P<0.001]and the neck angle was more tortile in the SIN group[(39.1±30.4)°vs.(25.1±15.4)°,P=0.036],as well maximum sac diameter was larger in the SIN group[(57.5±13.4)mm vs.(45.5±12.4)mm,P=0.016].Although the results showed no differences between the two groups regarding the oversize rate of the main body stent graft,endoleak in operative and perioperative period,as well the hospital stay,the operative time was significantly longer in the SIN group[(96.36±31.83)min vs.(63.58±26.68)min,P=0.001].Over the 3 years of follow-up(median time,18 months),there were significant differences between the two groups regarding the complication occurrence of endoleak,renal stent or iliac stent-graft stenosis/occlusion(P=0.012),and reintervention(P=0.044).Conclusion Data from this

关 键 词：腹主动脉瘤 腔内修复术 复杂瘤颈 内漏 

分 类 号：R654.3[医药卫生—外科学]