METHODS: From May 2018 to March 2022, 24 consecutive patients with non-ruptured AAAs demonstrating HNAs (neck length < 15 mm, or angulation > 60°) were treated with GORE Excluder Conformable AAA endoprosthesis (CLEVAR) (CEXC Device, W.L. Gore and Associates, Flagstaff, AZ, USA) at a Scottish vascular centre. We assessed clinical outcomes and technical success of CLEVAR during deployment, primary admission and the post-operative period at 3- and 12-month clinical follow-up alongside CT angiography.
RESULTS: Twenty-four patients (20 males, mean age 75.6) were included. Primary technical success of proximal seal zones and CLEVAR deployment (no type 1/3 endoleaks, no conversion to open repair, AAA excluded and patient leaving theatre alive) was achieved in 100% of patients. All patients were alive and clinically stable at 3- and 12-month follow-up. There were five patients requiring re-intervention; at the 3-month follow-up, one patient (4.2%) developed a type 1b endoleak requiring graft limb extension, one patient developed a right common femoral artery dissection requiring open repair and one patient required a limb extension of the right iliac limb due to risk of developing a type 1b endoleak. At the 12-month follow-up, two patients required embolization of type 2 endoleaks and no patients demonstrated type 1 or type 3 endoleaks.Conclusions: In-hospital and post-operative 3- and 12-month clinical and angiographic outcomes demonstrate safety and efficacy with CLEVARs in treating unruptured AAAs with HNA. Further research involving larger heterogenous sample sizes is warranted to determine long-term clinical outcomes.
方法:从2018年5月至2022年3月,连续24例未破裂的AAA表现为HNA(颈部长度<15mm,或角度>60°)用GORE排除器适形AAA内置假体(CLEVAR)(CEXC装置,W.L.GoreandAssociates,弗拉格斯塔夫,AZ,美国)在苏格兰血管中心。我们评估了CLEVAR在部署期间的临床结果和技术成功,主要入院和术后3个月和12个月临床随访以及CT血管造影。
结果:24名患者(20名男性,平均年龄75.6)包括在内。近端密封区和CLEVAR展开的主要技术成功(无1/3型内漏,没有转换为开放式修复,在100%的患者中,AAA被排除在外,并且患者活着离开手术室)。在3个月和12个月的随访中,所有患者均存活且临床稳定。有5名患者需要再次干预;在3个月的随访中,一名患者(4.2%)出现需要移植肢体伸展的1b型内漏,1例患者发生右侧股动脉夹层,需要进行开放性修复,1例患者由于有发生1b型内漏的风险,需要延长右侧髂肢.在12个月的随访中,2例患者需要栓塞2型内漏,无1型或3型内漏.结论:院内和术后3个月和12个月的临床和血管造影结果证明了CLEVAR治疗HNA未破裂的AAA的安全性和有效性。需要进一步研究涉及更大的异质性样本量,以确定长期临床结果。