先前已经报道了通气管/烟囱技术用于血管内主动脉瘤修复(ch-EVAR)的早期和短期疗效。然而,长期的CH-EVAR性能,血管通畅,和患者生存仍然未知。我们的研究评估了晚期结果,以确定PERICLES(烟囱技术治疗复杂主动脉病变的性能)注册表中失败的可能预测因素。
随着随访时间的延长,更新了2008年至2014年在PERICLES注册中接受ch-EVAR的患者的临床和影像学数据。回归模型用于评估相关的解剖和手术特征,作为影响后期结果的因素。我们关注随访≥30个月的患者(平均,46.6个月;范围,30-120个月)。
本分析包括来自最初的PERICLES注册的总共517名患者。平均随访时间从17.1个月更新为28.2个月(范围,1-120个月)。最新随访的全因死亡率为25.5%(n=132),估计患者生存率为87.6%,74.4%,1年、3年和5年为66.1%,分别。244名患者的亚组放置了387个烟囱移植物(335个肾动脉,42个肠系膜上动脉,10条腹腔动脉)和≥30个月的随访用于分析不良事件的特定解剖和设备预测因素。在子组中,技术成功率为88.9%,主要通畅率为94%,92.8%,92%,在2.5、3、4和5年时为90.5%,分别。平均动脉瘤囊消退为7.8±11.4mm(P<0.0001)。在24条目标血管中发生了烟囱移植物闭塞(6.2%)。5例患者需要晚期开放转换,其中2例患者为移植物内感染,2例患者为持续性Ia型内漏,1例患者为内阻。没有肾下颈部(赔率比,2.86;95%置信区间,1.32-6.19;P=.007)与长期设备相关并发症显着相关。密封区直径>30mm与持续性或晚期Ia型内漏显著相关(比值比,4.86;95%置信区间,1.42-16.59;P=.012)。
当前对PERICLES注册表的分析为ch-EVAR技术提供了缺少的长期经验,显示出良好的结果,超过一半的患者存活>5年,烟囱移植支血管通畅率为92%。不存在肾下颈部和密封区直径>30mm的治疗是该技术的主要解剖学长期限制。需要充分的术前规划和确定适当的适应症。
The early and short-term efficacy of the snorkel/chimney technique for endovascular aortic aneurysm repair (ch-EVAR) have been previously reported. However, long-term ch-EVAR performance, vessel patency, and patient survival remain unknown. Our study evaluated the late outcomes to identify possible predictors of failure within the PERICLES (performance of the chimney technique for the treatment of complex aortic pathologies) registry.
Clinical and radiographic data from patients who had undergone ch-EVAR from 2008 to 2014 in the PERICLES registry were updated with an extension of the follow-up. Regression models were used to evaluate the relevant anatomic and operative characteristics as factors influencing the late results. We focused on patients with ≥30 months of follow-up (mean, 46.6 months; range, 30-120 months).
A total of 517 patients from the initial PERICLES registry were included in the present analysis, from which the mean follow-up was updated from 17.1 months to 28.2 months (range, 1-120 months). All-cause mortality at the latest follow-up was 25.5% (n = 132), with an estimated patient survival of 87.6%, 74.4%, and 66.1% at 1, 3, and 5 years, respectively. A subgroup of 244 patients with 387 chimney grafts placed (335 renal arteries, 42 superior mesenteric arteries, 10 celiac arteries) and follow-up for ≥30 months was used to analyze specific anatomic and device predictors of adverse events. In the subgroup, the technical success was 88.9%, and the primary patency was 94%, 92.8%, 92%, and 90.5% at 2.5, 3, 4, and 5 years, respectively. The mean aneurysm sac regression was 7.8 ± 11.4 mm (P < .0001). Chimney graft occlusion had occurred in 24 target vessels (6.2%). Late open conversion was required in 5 patients for endograft infection in 2, persistent type Ia endoleak in 2, and endotension in 1 patient. The absence of an infrarenal neck (odds ratio, 2.86; 95% confidence interval, 1.32-6.19; P = .007) was significantly associated with long-term device-related complications. A sealing zone diameter >30 mm was significantly associated with persistent or late type Ia endoleak (odds ratio, 4.86; 95% confidence interval, 1.42-16.59; P = .012).
The present analysis of the PERICLES registry has provided the missing long-term experience for the ch-EVAR technique, showing favorable results with more than one half of the patients surviving for >5 years and a chimney graft branch vessel patency of 92%. The absence of an infrarenal neck and treatment with a sealing zone diameter >30 mm were the main anatomic long-term limits of the technique, requiring adequate preoperative planning and determination of the appropriate indication.