Evaluation of physician-modified endografts for the treatment of thoraco-abdominal and pararenal aortic pathologies at a single institution

被引:4
|
作者
Yang, Guangmin [1 ,2 ]
Zhao, Jie [1 ]
Zhang, Leiyang [2 ]
Zhang, Yepeng [1 ]
Li, Xiaoqiang [1 ]
Zhou, Min [1 ]
机构
[1] Nanjing Univ, Drum Tower Hosp, Sch Med, Dept Vasc Surg, 321 Zhong Shan Rd, Nanjing 210008, Peoples R China
[2] Nanjing Med Univ, Nanjing Hosp 1, Dept Thorac & Cardiovasc Surg, Nanjing, Peoples R China
来源
JOURNAL OF CARDIOVASCULAR SURGERY | 2021年 / 62卷 / 06期
关键词
Aortic aneurysm; Endovascular procedures; Aorta; ENDOVASCULAR REPAIR; FENESTRATIONS; DURABILITY; BRANCHES;
D O I
10.23736/S0021-9509.21.11877-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: This study aimed to describe the outcomes of high-risk patients with symptomatic or impending ruptured pararenal aneurysm and thoraco-abdominal aortic aneurysm with comorbidities unsuitable for conventional open surgery, using physician-modified endografts METHODS: A single-center retrospective analysis was conducted on 59 patients (mean age: 75 years; 47 males) treated with PMEGs between 2017 and 2020. Data on baseline characteristics, procedures, and clinical follow-up were collected to retrospectively analyze early (technical success, perioperative mortality, and major adverse events) and late (patency, endoleak, intervention, aneurysm thrombosis, and survival) out RESULTS: Technical success was achieved in 96.6% (57/59) of cases. The 30-day mortality rate was 5.1% (3/59). Five patients suffered renal failure and required temporary or permanent dialysis, one developed respiratory failure, and one suffered bowel ischemia. The major stroke rate was 3.4%, the spinal cord injury rate was 0%, and the myocardial infarction rate was 3.4%. During a mean follow-up period of 18.8 +/- 9.2 months, one patient suffered upper gastrointestinal bleeding and died after 7 postoperative months. Primary branch patency was observed in 97.2% of target vessels. Estimated freedom from reintervention was 88.1% and 87.5% at 6 months and 1 year, respectively. Five cases of endoleak (one type I, one type II, and three type III) were detected, and 7.1% required reintervention. The aneurysmal lumen thrombosis rate at 1 year was 89.6%. The estimated overall survival rate was 94.9% and 92.9% at 6 and 12 months, respectively. CONCLUSIONS: When used by experienced teams under appropriate anatomical conditions, PMEGs are a safe and effective alternative to open surgery. However, further technical advancement and larger studies with long-term follow-up periods are warranted. (Cite this article as: Yang G, Zhao J, Zhang L, Zhang Y, Li X, Zhou M. Evaluation of physician-modified endografts for the treatment of thoracoabdominal and pararenal aortic pathologies at a single institution. J Cardiovasc Surg 2021;62:582-90. DOI: 10.23736/S0021-9509.21.11877-4)
引用
收藏
页码:582 / 590
页数:9
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