Impact of stent-graft complexity on mid-term results in fenestrated endovascular aortic repair of juxtarenal and suprarenal abdominal aortic aneurysms.

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Surgery Pub Date : 2023-06-01 DOI:10.23736/S0021-9509.22.12311-6

Ozan Yazar, Gabriela Pilz da Cunha, Michiel W de Haan, Barend M Mees, Geert W Schurink

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Abstract

Background: The impact of stent-graft complexity on clinical outcome after fenestrated endovascular aortic aneurysm repair (FEVAR) has been conflicting in the literature. The objective of this study was to compare mid-term results of stent-grafts with renal fenestrations alone with more complex stent-grafts including mesenteric fenestrations.

Methods: A single center retrospective study was conducted on 154 patients, who underwent FEVAR from 2006 to 2020 at our institution.

Results: There were 54 (35.1%) patients in the renal FEVAR group and 100 (64.9%) patients in the complex FEVAR group. Median follow-up of the total group was 25 months (IQR 7-45). There were no significant differences in technical success and perioperative mortality. Intraoperative complications (4% vs. 18%, P=0.001), operative time (145 min vs. 191 min, P=0.001), radiation dose (119372 mGy*cm² vs. 159573 mGy*cm², P=0.004) and fluoroscopy time (39 min vs. 54 min, P=0.007) were significantly lower in the renal FEVAR group. During follow-up target vessel instability, endoleaks and reinterventions were not significantly different between the two groups.

Conclusions: In this single center retrospective study, renal FEVAR was a safe and effective treatment for patients with juxtarenal AAA demonstrating fewer intraoperative complications and similar mid-term outcomes as complex FEVAR. If the anatomy is compatible for renal FEVAR, it might be unnecessary to expose patients to potentially more complications by choosing a complex FEVAR strategy.

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支架复杂性对开窗腔内修复肾旁和肾上腹主动脉瘤中期疗效的影响。

背景:支架移植复杂性对开窗血管内动脉瘤修复(FEVAR)后临床结果的影响在文献中一直存在矛盾。本研究的目的是比较单独肾开孔支架移植和更复杂的包括肠系膜开孔支架移植的中期结果。方法:对我院2006 ~ 2020年收治的154例FEVAR患者进行单中心回顾性研究。结果:肾性FEVAR组54例(35.1%)，复合性FEVAR组100例(64.9%)。全组中位随访25个月(IQR 7-45)。技术成功率和围手术期死亡率无显著差异。肾脏FEVAR组术中并发症(4% vs. 18%， P=0.001)、手术时间(145 min vs. 191 min, P=0.001)、放射剂量(119372 mGy*cm2 vs. 159573 mGy*cm2, P=0.004)、x线检查时间(39 min vs. 54 min, P=0.007)均显著降低。在随访中，两组间靶血管不稳定、内漏和再干预均无显著差异。结论:在本单中心回顾性研究中，肾性FEVAR是一种安全有效的治疗肾旁AAA患者的方法，术中并发症较少，中期预后与复杂FEVAR相似。如果解剖结构与肾脏FEVAR相匹配，可能没有必要通过选择复杂的FEVAR策略使患者暴露于潜在的更多并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Surgery 医学-外科

CiteScore

2.50

自引率

7.10%

发文量

204

审稿时长

4-8 weeks

期刊介绍： The Journal of Cardiovascular Surgery publishes scientific papers on cardiac, thoracic and vascular surgery. Manuscripts may be submitted in the form of editorials, original articles, review articles, case reports, therapeutical notes, special articles and letters to the Editor. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (www.icmje.org). Articles not conforming to international standards will not be considered for acceptance.