腹主动脉瘤腔内治疗现状

doi:10.6040/j.issn.1671-7554.0.2024.0305

摘要/Abstract

摘要： 腔内修复已成为腹主动脉瘤(abdominal aortic aneurysm, AAA)治疗的首选策略。近些年腔内技术迅猛发展,面对不同类型的AAA,涌现出以“开窗”“烟囱”、分支技术为代表的创新技术,而且基于这些技术也设计出了诸多成品化的新型支架。本文从技术、循证、指南三个角度对现阶段不同解剖类型的腹主动脉瘤腔内修复现状进行述评,并对备受关注的并发症问题进行阐述。

关键词: 腹主动脉瘤, 主动脉腔内修复术, 开窗技术, 烟囱技术, 分支技术

Abstract: Endovascular repair has become the preferred strategy for the treatment of abdominal aortic aneurysm(AAA). In recent years, endovascular technology has developed rapidly, and innovative techniques represented by "fenestration", "chimney", and branch technology have emerged to address different types of AAA. Based on these techniques, many new types of off-the-shelf stents have also been designed. This article provides a review of the current status of endovascular repair for different anatomical types of AAA from the perspectives of technical aspects, evidence-based medicine, and clinical guidelines. It also addresses the highly concerning issue of complications.

Key words: Abdominal aortic aneurysm, Endovascular aortic repair, Fenestrated technique, Chimney technique, Branched technique

中图分类号:

R543.1+6

卫任,郭伟. 腹主动脉瘤腔内治疗现状[J]. 山东大学学报 (医学版), 2024, 62(9): 13-18.

WEI Ren, GUO Wei. Current status of endovascular therapy for abdominal aortic aneurysm[J]. Journal of Shandong University (Health Sciences), 2024, 62(9): 13-18.

参考文献

[1] Volodos NL, Shekhanin VE, Karpovich IP, et al. A self-fixing synthetic blood vessel endoprosthesis [Russian] [J]. Vestn Khir Im I I Grek, 1986, 137(11): 123-125.
[2] Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms[J]. Ann Vasc Surg, 1991, 5(6): 491-499.
[3] Youssef S, Elkawafi M, Peysner R, et al. A review of UK-based national and international scientific meeting published abstracts in response to the draft NICE aortic aneurysm guidelines[J]. Ann Vasc Surg, 2021, 75: 358-367. doi:10.1016/j.avsg.2021.01.120.
[4] 中华医学会外科学分会血管外科学组.腹主动脉瘤诊断和治疗中国专家共识(2022版)[J].中国实用外科杂志, 2022, 42(4): 380-387. Society for Vascular Surgery, Chinese Society of Surgery, Chinese Medical Association. Chinese Expert Consensus on the diagnosis and treatment of abdominal aortic aneurysm(2022 edition)[J]. Chinese Journals of Practical Medicine, 2022, 42(4): 380-387.
[5] Chaikof EL, Brewster DC, Dalman RL, et al. SVS practice guidelines for the care of patients with an abdominal aortic aneurysm: executive summary[J]. J Vasc Surg, 2009, 50(4): 880-896.
[6] Wanhainen A, Van Herzeele I, Goncalves FB, et al. Editors choice: European Society for Vascular Surgery(ESVS)2024 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms[J]. Eur J Vasc Endovasc Surg, 2024, 67(2): 192-331.
[7] Marbacher S, Wanderer S, Strange F, et al. Saccular aneurysm models featuring growth and rupture: a systematic review[J]. Brain Sci, 2020, 10(2): 101.
[8] Calero A, Illig KA. Overview of aortic aneurysm management in the endovascular era[J]. Semin Vasc Surg, 2016, 29(1/2): 3-17.
[9] Chaikof EL, Dalman RL, Eskandari MK, et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm[J]. J Vasc Surg, 2018, 67(1): 2-77.
[10] Ulug P, Sweeting MJ, von Allmen RS, et al. Morphological suitability for endovascular repair, non-intervention rates, and operative mortality in women and men assessed for intact abdominal aortic aneurysm repair: systematic reviews with meta-analysis[J]. Lancet, 2017, 389(10088): 2482-2491.
[11] Karaolanis G, Antonopoulos CN, Koutsias S, et al. Outcomes of endosutured aneurysm repair with the Heli-FX EndoAnchor implants[J]. Vascular, 2020, 28(5): 568-576.
[12] 张宏鹏, 章希炜, 戴向晨, 等. 国产新型覆膜支架系统治疗腹主动脉瘤早期临床结果的多中心分析 [J]. 中华外科杂志, 2022, 60(12): 1049-1056.
[13] van Schaik TG, Yeung K, Verhagen H, et al. Long-term survival and secondary procedures after open or endovascular repair of abdominal aortic aneurysms[J]. J Vasc Surg, 2017, 66: 1379-1389. doi:10.1016/j.jvs.2017.05.122.
[14] Lederle FA, Kyriakides TC, Stroupe KT, et al. Open versus endovascular repair of abdominal aortic aneurysm[J]. N Engl J Med, 2019, 380(22): 2126-2135.
[15] Patel R, Sweeting MJ, Powell JT, et al. Endovascular versus open repair of abdominal aortic aneurysm in 15-years follow-up of the UK endovascular aneurysm repair trial 1(EVAR trial 1): a randomised controlled trial[J]. Lancet, 2016, 388(10058): 2366-2374.
[16] Greenhalgh RM, Brown LC, Kwong GP, et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm(EVAR trial 1), 30-day operative mortality results: randomised controlled trial[J]. Lancet, 2004, 364(9437): 843-848.
[17] Antoniou GA, Antoniou SA, Torella F. Editors choice-endovascular vs. open repair for abdominal aortic aneurysm: systematic review and meta-analysis of updated peri-operative and long term data of randomised controlled trials[J]. Eur J Vasc Endovasc Surg, 2020, 59(3): 385-397.
[18] Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines[J]. Circulation, 2022, 146(24): e334-e482.
[19] Dingemans SA, Jonker FHW, Moll FL, et al. Aneurysm sac enlargement after endovascular abdominal aortic aneurysm repair[J]. Ann Vasc Surg, 2016, 31: 229-238. doi:10.1016/j.avsg.2015.08.011.
[20] Seike Y, Matsuda H, Shimizu H, et al. Nationwide analysis of persistent type II endoleak and late outcomes of endovascular abdominal aortic aneurysm repair in Japan: a propensity-matched analysis[J]. Circulation, 2022, 145(14): 1056-1066.
[21] Menges AL, Meuli L, Dueppers P, et al. Relevance of type II endoleak after endovascular repair of ruptured abdominal aortic aneurysms: a retrospective single-center cohort study[J]. J Endovasc Ther, 2023, 30(4): 540-549.
[22] Wang YL, Yuan F, Bai YW, et al. Natural history and influence on long-term outcomes of isolated type II endoleak after endovascular aneurysm repair: a 10-year experience at a single center[J]. Rev Cardiovasc Med, 2022, 23(3): 99.
[23] Powell JT, Sweeting MJ, Ulug P, et al. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years[J]. J Vasc Surg, 2017, 65(5): 1539-1540.
[24] Jongkind V, Yeung KK, Akkersdijk GJM, et al. Juxtarenal aortic aneurysm repair[J]. J Vasc Surg, 2010, 52(3): 760-767.
[25] Park JH, Chung JW, Choo IW, et al. Fenestrated stent-grafts for preserving visceral arterial branches in the treatment of abdominal aortic aneurysms: preliminary experience[J]. J Vasc Interv Radiol, 1996, 7(6): 819-823.
[26] Farber MA, Vallabhaneni R. Moving into the paravisceral aorta using fenestrated and branched endografts[J]. Semin Vasc Surg, 2012, 25(4): 193-199.
[27] Mohabbat W, Greenberg RK, Mastracci TM, et al. Revised duplex criteria and outcomes for renal stents and stent grafts following endovascular repair of juxtarenal and thoracoabdominal aneurysms[J]. J Vasc Surg, 2009, 49(4): 827-837.
[28] Tambyraja AL, Fishwick NG, Bown MJ, et al. Fenestrated aortic endografts for juxtarenal aortic aneurysm: medium term outcomes[J]. Eur J Vasc Endovasc Surg, 2011, 42(1): 54-58.
[29] Haulon S, Amiot S, Magnan PE, et al. An analysis of the French multicentre experience of fenestrated aortic endografts[J]. Ann Surg, 2010, 251(2): 357-362.
[30] ONeill S, Greenberg RK, Haddad F, et al. A prospective analysis of fenestrated endovascular grafting: intermediate-term outcomes[J]. Eur J Vasc Endovasc Surg, 2006, 32(2): 115-123.
[31] Greenberg RK, Clair D, Srivastava S, et al. Should patients with challenging anatomy be offered endovascular aneurysm repair? [J]. J Vasc Surg, 2003, 38(5):990-996.
[32] Özdemir-van Brunschot DMD, Torsello GB, Bernardini G, et al. Use of chimney technique does not improve the outcome of endovascular aneurysm repair in patients with a hyperangulated and short proximal aortic neck[J]. J Endovasc Ther, 2022, 29(3): 361-369.
[33] Coscas R, Kobeiter H, Desgranges P, et al. Technical aspects, current indications, and results of chimney grafts for juxtarenal aortic aneurysms[J]. J Vasc Surg, 2011, 53(6): 1520-1527.
[34] Tanious A, Lee JT, Shames M. Snorkel endovascular abdominal aortic aneurysm repair versus fenestrated endovascular aneurysm repair: is it a competition?[J]. Semin Vasc Surg, 2016, 29(1/2): 68-73.
[35] Wilson A, Zhou S, Bachoo P, et al. Systematic review of chimney and periscope grafts for endovascular aneurysm repair[J]. Br J Surg, 2013, 100(12): 1557-1564.
[36] Caradu C, Berard X, Sassoust G, et al. Chimney versus fenestrated endovascular aortic repair for juxta-renal aneurysms[J]. J Cardiovasc Surg, 2018, 59(4): 600-610.
[37] Moulakakis KG, Mylonas SN, Avgerinos E, et al. The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies[J]. J Vasc Surg, 2012, 55(5): 1497-1503.
[38] Kasirajan K. Branched grafts for thoracoabdominal aneurysms: off-label use of FDA-approved devices[J]. J Endovasc Ther, 2011, 18(4): 471-476.
[39] Trellopoulos G, Georgakarakos E, Pelekas D, et al. Chimney and periscope technique for emergent treatment of spontaneous aortic rupture[J]. Ann Vasc Surg, 2014, 28(5): 1324-1328.
[40] 郭伟, 王嘉宾. 胸腹主动脉瘤腔内治疗进展[J]. 中华血管外科杂志, 2022, 7(3): 151-155.
[41] 高江平, 郭伟. 开窗与分支技术治疗复杂腹主动脉瘤的现状与评价[J]. 中华血管外科杂志, 2022, 7(2): 82-88.
[42] Behzadi F, Simon JE, Zielke TJ, et al. Risk factors associated with spinal cord ischemia during aortic aneurysm repair[J]. Ann Vasc Surg, 2023, 91: 36-49. doi:10.1016/j.avsg.2022.12.079.
[43] Konstantinou N, Antonopoulos CN, Jerkku T, et al. Systematic review and meta-analysis of published studies on endovascular repair of thoracoabdominal aortic aneurysms with the t-Branch off-the-shelf multibranched endograft[J]. J Vasc Surg, 2020, 72(2): 716-725.
[44] Dias-Neto M, Reis PV, Rolim D, et al. Strategies to prevent TEVAR-related spinal cord ischemia[J]. Vascular, 2017, 25(3): 307-315.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed