European Journal of Vascular and Endovascular Surgery最新文献

Objective: Previous studies showed that branched endovascular aneurysm repair (BEVAR) carries a significant risk for adverse renal events. The purpose of this study was to evaluate the performance of the balloon expandable covered stent graft (BECS) Advanta/iCast V12, the Viabahn balloon expandable (VBX), and the BECS Advanta combined with a distal deployed self expanding covered stent (SECS) Viabahn (VSX) as bridging stent grafts (BSGs) in renal arteries.

Methods: A retrospective analysis of prospectively collected data was conducted at a single centre. Patients undergoing BEVAR who had at least one Advanta, Advanta + VSX, or VBX as BSG in renal arteries were included. Endpoints were patency, endoleaks, target vessel instability (TVI), re-interventions, as well as clinical outcomes including kidney function, new dialysis needs, and death. Data were analysed using Kaplan-Meier estimations and multivariable Cox regression.

Results: The study included 255 patients with 431 BSGs in renal arteries treated for complex aortic repair between 2010 and 2019. Advanta was predominantly used in 2010 - 2014, Advanta + VSX in 2015 - 2017, and VBX in 2018 - 2019. Overall, 125 Advanta, 146 Advanta + VSX, and 160 VBX were implanted. Median follow up time was 19.3 months. At three years, estimated primary patencies were 82.7 ± 4.6% for renal arteries treated with Advanta, 96.8 ± 1.8% for Advanta + VSX, and 89.0 ± 3.2% for VBX. Estimated freedom from TVI at three years was 82.4 ± 4.7% for renal arteries treated with Advanta, 94.1 ± 2.4% for Advanta + VSX, and 85.4 ± 3.5% for VBX. Freedom from re-intervention estimations at three years were 86.3 ± 3.4% in the Advanta cohort, 95.1 ± 2.0% in the Advanta + VSX cohort, and 91.6 ± 2.4% in the VBX cohort.

Conclusion: The combination of BECS and SECS seems to be superior in terms of primary patency compared with BECS alone.

Objective: Patients with abdominal aortic aneurysm (AAA) have higher mortality due to increased cardiovascular risk. This retrospective study provides an overview of cardiovascular comorbidities and medication prescriptions in patients with AAA over different time periods.

Methods: This single centre, retrospective cohort study included all patients with AAA at Amsterdam University Medical Centers from January 1989 to July 2023. Trends in cardiovascular comorbidities and medication prescriptions at AAA diagnosis were assessed across six periods: 1989 - 1998, 1999 - 2003, 2004 - 2008, 2009 - 2013, 2014 - 2018, and 2019 - 2023. Two year survival rates were analysed, and a multivariable Cox proportional hazards model was used to examine the association between cardiovascular comorbidities and medication prescriptions with all cause death.

Results: The study included 7 957 patients (78.8% male; mean age 71.8 ± 9.9 years). Common cardiovascular comorbidities at AAA diagnosis were hypertension (39.7%), transient ischaemic attack (27.1%), and myocardial infarction (17.5%). Frequently prescribed medications included platelet inhibitors (40.5%), beta blockers (28.9%), and statins (27.4%). Over time, cardiovascular comorbidities, medication prescriptions, and age at diagnosis increased. The two year survival rate was 77.7% (95% confidence interval 76.6 - 78.7%), with a significant increase in all cause death over time (log rank p < .001). Advanced age (p < .001; hazard ratio [HR] 1.065), chronic renal failure (p < .001; HR 1.545), heart failure (p = .002; HR 1.198), and chronic obstructive pulmonary disease (p < .001; HR 1.354) were associated with increased mortality risk, whereas dyslipidaemia (p < .001; HR 0.818) was associated with a decreased risk. Insulin (p < .001; HR 1.373) and diuretic use (p < .001; HR 1.223) were associated with increased mortality risk, whereas platelet inhibitors (p = .006; HR 0.899) and nitrates (p = .031; HR 0.858) were linked to a decreased risk.

Conclusion: Cardiovascular comorbidities and medication prescriptions have increased over time in patients with AAA. Low prescription rates of cardiovascular medication at diagnosis suggest inadequate risk management, emphasising the need for stricter cardiovascular risk management to reduce mortality.

Objective: To investigate outcomes obtained using an off the shelf pre-loaded inner branched endograft (E-nside) for the treatment of juxtarenal and pararenal aortic aneurysms (J-PRAA).

Methods: Data from a multicentre registry (INBREED), including patients treated with E-nside endograft, were prospectively collected and analysed. Patients treated for J-PRAA were included. Pre-operative clinical and anatomical characteristics, procedural data, 30 day, and one year outcomes were recorded. Endpoints were technical success, 30 day mortality, major adverse events (MAE), and one year freedom from target vessel instability.

Results: Of 185 consecutive treated patients, 47 (25.0%) had a J-PRAA (juxtarenal n = 10, 21.0%; pararenal n = 37, 79.0%) and were included; 183 target vessels were incorporated through an inner branch. Procedural setting was emergent or urgent in 18 patients (38.0%) owing to a contained aortic rupture (n = 2, 4.0%), symptomatic aneurysm (n = 4, 9.0%), or aneurysm > 70 mm (n = 12, 87.0%). Mean length of aortic coverage above the coeliac trunk was 116 ± 7 mm. Technical success was 100%, and 30 day mortality was 4.0% (n = 2 urgent cases). The thirty day cumulative MAE rate was 26.0% (n = 12): two stroke (4.0%); seven spinal cord ischaemia (15.0%); six in an elective setting (20.0%) and one in an urgent setting (6.0%), and five leading to permanent paraplegia/paraparesis (10.0%). Freedom from target vessel instability was 99.0% after 30 days and 97.0 ± 3.0% after one year.

Conclusion: Use of an off the shelf inner branched device for treating J-PRAA was feasible in urgent and elective settings, with high technical success and satisfactory target vessel stability at one year. In the treatment of J-PRAA, stroke and spinal cord ischaemia may be associated with arm access and increased aortic coverage that the design brings.

Objective: The aim of this study was to prospectively evaluate the real world outcomes of the E-liac stent graft system used to electively treat common iliac artery aneurysms, either unilaterally or bilaterally.

Methods: PLIANTII is an observational, prospective, non-randomised, multicentre study. The E-liac stent graft system was implanted for the treatment of iliac artery aneurysms in 295 patients across 30 European centres between September 2018 and September 2023, with 236 patients also treated for a concomitant infrarenal abdominal aortic aneurysm. The endpoints, including clinical outcomes, are reported up to the twelve month follow up. The primary endpoint was a composite of freedom from endoleak type I or III plus patency of the external iliac artery (EIA) and internal iliac artery (IIA) on the E-liac implantation side(s) at the twelve month follow up. Technical success was defined as successful access and deployment of the stent graft without surgical conversion, death, type I or III endoleak, or graft limb occlusion, assessed at discharge or 30 days. Clinical success, evaluated at twelve months, also included the absence of stent graft infection and iliac aneurysm rupture.

Results: A total of 295 consecutive patients (95.6% male; mean age 72.7 years) were included. The primary endpoint was achieved in 91.8%. No death was recorded within 30 days after implantation, and seven deaths had occurred at twelve months. The Kaplan-Meier estimated survival rate until the twelve month follow up visit was 96.7 ± 1.2%. Technical success at discharge or 30 days was achieved in 93.1% of patients, while clinical success at twelve months was achieved in 91.2%. There were 5.4% re-interventions within 30 days and 12.9% within twelve months. The Kaplan-Meier estimated freedom from E-liac related re-intervention until the twelve month follow up visit was 91.3 ± 1.8%. The primary patency rate at discharge or 30 day visit was 97.6% (284/291) for the EIA and 96.2% (280/291) for the IIA, whereas Kaplan-Meier estimated freedom from occlusion up to twelve months was 94.5 ± 1.6% for the EIA and 94.7 ± 1.5% for the IIA.

Conclusion: The one year data from the PLIANTII study show that treatment with the E-liac stent graft system is safe and results in good technical and clinical success rates.