■为了评估血管内碎石术(IVL)用于经股腹部(EVAR)的可行性和安全性,胸部(TEVAR),和胸腹(BEVAR)血管内修复狭窄和钙化的患者的动脉瘤。
■连续接受IVL治疗的患者在EVAR之前出现严重钙化和狭窄的髂入路,TEVAR,或BEVAR在2020年11月至2022年6月之间进行了回顾性评估。所有解剖特征均通过术前计算机断层扫描血管造影(CTA)的多平面重建获得。血管通路的敌意根据外周动脉钙评分系统(PACSS)和钙化通路严重程度评分(CASS)进行分类,考虑解剖学(钙等级和长度,最小管腔直径[MLD],和弯曲指数)和主动脉支架(SG/MLD指数)参数。主要终点是技术上的成功,定义为成功的主动脉内移植和部署,而没有ilian破裂。另外分析了无并发症和原发通畅性。
■对20例患者(平均年龄74.5±6.7岁)的28个髂轴(8个双侧)进行IVL治疗,平均随访时间为26.5±6.2(范围17-36)个月。10例患者接受EVAR:3TEVAR,和7个BEVAR程序。14名患者(70%)动脉瘤疾病与症状性主动脉-髂动脉闭塞性疾病(AIOD)相关,卢瑟福三级到四级.在89%的病例中,PACSS为IV级,在所有病例中,CASS(平均14±2)为III至IV级。支架(SG)外径(5.60±1.65mm)明显大于MLD(3.96±1.20mm)50%,SG/MLD指数为1.50±0.51(p<0.001)。技术成功100%。没有解剖,破裂,或发生远端栓塞。IVL治疗后,需要一个(3.4%)释放支架作为血管内导管。1个月CTA显示术后管腔增加增加93%(p<0.001)。在最后一次随访时,所有AIOD患者的主要通畅率为100%,均改善了2个卢瑟福班。
■这项研究显示了IVL作为治疗狭窄和钙化的髂动脉以促进移植物内移植的有价值的选择的安全性和可行性。进一步的研究将有助于证实这些结果。
结论:在本文中,探讨了使用血管内动脉碎石术促进主动脉内移植的方法。髂动脉严重钙化的存在仍然是主动脉腔内修复术的禁忌症。血管内碎石术增加了主动脉腔内手术的可行性和安全性,通过改善血管顺应性和管腔增益,促进移植物递送并降低髂动脉破裂和/或夹层的风险。这种新颖的血管制备方法可以替代“铺路和破裂”和/或髂导管。这项研究描述了一个新的评分来分类髂钙化的严重程度,考虑解剖参数和主动脉移植输送系统的轮廓。
UNASSIGNED: To assess the feasibility and safety of intravascular lithotripsy (IVL) for enabling transfemoral abdominal (EVAR), thoracic (TEVAR), and thoracoabdominal (BEVAR) endovascular aneurysm repair in patients with narrow and calcified iliac arteries.
UNASSIGNED: Consecutive patients treated with IVL for severe calcified and narrowed iliac access before EVAR, TEVAR, or BEVAR between November 2020 and June 2022 were retrospectively evaluated. All anatomical iliac characteristics were acquired by multi-planar reconstruction of preoperative computed tomography angiography (CTA). The hostility of the vascular accesses was classified based on Peripheral Arterial Calcium Scoring System (PACSS) and calcified access severity score (CASS), a new score considering both anatomical (calcium grade and length, minimum lumen diameter [MLD], and tortuosity index) and aortic stent-graft (SG/MLD index) parameters. Primary endpoint was technical success defined as successful aortic endograft delivery and deployment without iliac rupture. Freedom from complications and primary patency were additionally analyzed.
UNASSIGNED: Twenty-eight iliac axes were treated with IVL (8 bilateral) in 20 patients (mean age 74.5±6.7 years) with a mean follow-up of 26.5±6.2 (range 17-36) months. Ten patients underwent EVAR: 3 TEVAR, and 7 BEVAR procedures. In 14 patients (70%), aneurysm disease was associated with symptomatic aorto-iliac occlusive disease (AIOD), with Rutherford class III to IV. The PACSS was grade IV in 89% of the cases and the CASS (mean 14±2) was grade III to IV in all cases. The stent-graft (SG) outer diameter (5.60±1.65 mm) was significantly larger by 50% than MLD (3.96±1.20 mm), with an SG/MLD index of 1.50±0.51 (p<0.001). Technical success was 100%. No dissection, rupture, or distal embolization occurred. One (3.4%) bail-out stenting was necessary as endoconduit after IVL treatment. One month CTA showed that postoperative luminal gain increased by 93% (p<0.001). An improvement of 2 Rutherford classes occurred in all AIOD patients with a primary patency of 100% at last follow-up.
UNASSIGNED: This study shows the safety and feasibility of IVL as a valuable option to treat narrow and calcified iliac arteries to facilitate endograft delivery. Further studies will be useful to confirm these results.
CONCLUSIONS: In this article, the use of intravascular iliac artery lithotripsy to facilitate aortic endograft delivery is explored. The presence of iliac severe calcifications still represents a contraindication for aortic endovascular repair. Intravascular lithotripsy increases the feasibility and safety of endovascular aortic procedures, facilitating endograft delivery and reducing the risk of iliac rupture and/or dissections by improving vessel compliance and luminal gain. This novel vessel preparation could be an alternative to \"paving and cracking\" and/or iliac conduits. This study describes a new score to classify the severity of iliac calcifications, considering anatomical parameters and the profile of aortic endografts delivery system.