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用预防性栓塞进行两阶段内血管动脉瘤修复:一项回顾性研究

Shuhei Azuma¹, Ryo Shimada¹, Kazuto Maeda¹

¹The Department of Cardiovascular Surgery, Kyoto Katsura Hospital, Kyoto City, Kyoto Prefecture, Japan.

Annals of vascular surgery

|November 8, 2023

概括

血管内动脉瘤修复 (EVAR) 的两阶段方法,涉及下层介质动脉和腰椎动脉的先发性栓塞,有效地防止II型内泄漏. 这种方法还可以减少操作时间,对比介质和辐射暴露,而不是同时进行的手术.

科学领域:

血管外科血管外科
干预性放射学干预性放射学
医疗器械技术医疗器械技术

背景情况:

二型内 (T2EL) 是内血管动脉瘤修复 (EVAR) 后的常见并发症.
来自下半腹动脉 (IMA) 和腰椎动脉 (LAs) 的逆向输液可以导致不良事件,包括囊和破裂.
这些动脉的预防性栓塞是一种预防T2EL和减少动脉瘤囊大小的策略.

研究的目的:

为了评估两阶段EVAR方法的有效性.
评估分离栓塞和EVAR程序对T2EL发生的影响.
为了比较操作时间,对比介质的使用和同时和双阶段程序之间的辐射暴露.

主要方法:

对114个EVAR病例 (2019年1月至2022年12月) 的回顾性分析.
患者被分为一个同时进行的组 (栓塞和EVAR组合,n=49) 和一个两阶段的组 (栓塞和EVAR在不同的天,n=30).
主要终点包括T2EL发生率和IMA/LA栓塞率.

主要成果:

在两阶段组 (35个月随访) 中没有T2EL发生,而在同时治疗组 (28个月随访) 中为8.2%.
两阶段组的整体手术时间比同步组 (340分钟) 缩短了304分钟.
两阶段组显示对比介质使用和辐射暴露减少,LA栓塞率显著提高 (87.9%vs74.3%).

结论:

具有预防性IMA和LA栓塞的两阶段EVAR策略在预防T2EL方面是有效的.
这种方法导致整体操作时间缩短,对比介质消耗和辐射暴露.
这种两阶段的方法证明了改善的技术结果,特别是腰椎动脉栓塞率.

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