目的:评估开窗式/分枝式主动脉腔内修复术(F/BEVAR)治疗复杂主动脉瘤的5年结局。
方法:诊断为复杂主动脉瘤的患者,在单中心接受F/BEVAR的患者被纳入本研究并进行回顾性分析.根据动脉瘤程度划分队列,比较第1组(I-III型胸腹动脉瘤-TAAA),第2组(IV型TAAA),和第3组(近交系,pararenal,或胸膜旁主动脉瘤-JRAA,PRAA,PVAA)。主要终点是30天和5年生存率。次要终点是技术成功,脊髓缺血的发生,内脏动脉的原发性通畅,免于目标血管不稳定,和次要干预。
结果:在2012年7月至2023年5月期间接受F/BEVAR的436例患者中,有131例表现为I-III型TAAA,具有IV型TAAA的69,和236与JRAA,PRAA,或PVAA。所有病例均根据医生赞助的IDE方案,使用特定于患者的公司制造或现成的设备进行治疗。第1组比第2组或第3组明显年轻(69.6±8.7vs72.4±7.1vs73.2±7.3,P<.001),女性比例更高(50.4%vs21.7%vs17.8%,P<.001)。在第1组患者中,主动脉夹层的既往病史明显更为常见(26%vs1.4%vs0.9%,P<.001),第1组的平均动脉瘤直径较大(64.5vs60.7vs63.2mm,P=.033)。两组的合并症相似,除了冠状动脉疾病(P<0.001)和烟草使用(P=0.003),在第1组中不那么普遍。三组的技术成功率相似(98.5%vs98.6%vs98.7%,P>.99)。30天死亡率为4.5%,1.4%,和0.4%,分别在第1、2和3组中,与第3组相比,第1组明显更高(P=0.01)。与第3组相比,第1组的脊髓缺血发生率明显更高(5.3vs4.3%vs.4%,P=.004)。与第1组相比,第3组的5年生存率明显更高(P=0.01)。与第1组相比,第3组的二级干预自由度明显更高(P=0.003)。在5年,在所检查的1652条靶血管中,各组间的靶血管不稳定情况或原发通畅情况无显著差异.
结论:较大的动脉瘤范围与较低的5年生存率相关,30天死亡率更高,次要干预的发生率,脊髓缺血.在接受F/BEVAR治疗的复杂主动脉瘤患者中,所有组的次要干预措施的发生率使细致的随访至关重要。
OBJECTIVE: The aim of this study was to evaluate the 5-year outcomes of fenestrated/branched endovascular aortic repair (F/BEVAR) for the treatment of complex aortic aneurysms stratified by the aneurysm extent.
METHODS: Patients with the diagnosis of complex aortic aneurysm, who underwent F/BEVAR at a single center were included in this study and retrospectively analyzed. The cohort was divided according to the aneurysm extent, comparing group 1 (types I-III thoracoabdominal aneurysms [TAAAs]), group 2 (type IV TAAAs), and group 3 (juxtarenal [JRAAs], pararenal [PRAAs], or paravisceral [PVAAs] aortic aneurysms). The primary endpoints were 30-day and 5-year survival. The secondary endpoints were technical success, occurrence of spinal cord ischemia, primary patency of the visceral arteries, freedom from target vessel instability, and secondary interventions.
RESULTS: Of 436 patients who underwent F/BEVAR between July 2012 and May 2023, 131 presented with types I to III TAAAs, 69 with type IV TAAAs, and 236 with JRAAs, PRAAs, or PVAAs. All cases were treated under a physician-sponsored investigational device exemption protocol with a patient-specific company-manufactured or off-the-shelf device. Group 1 had significantly younger patients than group 2 or 3 respectively (69.6 ± 8.7 vs 72.4 ± 7.1 vs 73.2 ± 7.3 years; P < .001) and had a higher percentage of females (50.4% vs 21.7% vs 17.8%; P < .001). Prior history of aortic dissection was significantly more common among patients in group 1 (26% vs 1.4% vs 0.9%; P < .001), and mean aneurysm diameter was larger in group 1 (64.5 vs 60.7 vs 63.2 mm; P = .033). Comorbidities were similar between groups, except for coronary artery disease (P < .001) and tobacco use (P = .003), which were less prevalent in group 1. Technical success was similar in the three groups (98.5% vs 98.6% vs 98.7%; P > .99). The 30-day mortality was 4.5%, 1.4%, and 0.4%, in groups 1, 2, and 3, respectively, and was significantly higher in group 1 when compared with group 3 (P = .01). The incidence of spinal cord ischemia was significantly higher in group 1 compared with group 3 (5.3% vs 4.3% vs 0.4%; P = .004). The 5-year survival was significantly higher in group 3 when compared with group 1 (P = .01). Freedom from secondary intervention was significantly higher in group 3 when compared with group 1 (P = .003). At 5 years, there was no significant difference in freedom from target vessel instability between groups or primary patency in the 1652 target vessels examined.
CONCLUSIONS: Larger aneurysm extent was associated with lower 5-year survival, higher 30-day mortality, incidence of secondary interventions, and spinal cord ischemia. The prevalence of secondary interventions in all groups makes meticulous follow-up paramount in patients with complex aortic aneurysm treated with F/BEVAR.