Analysis of factors influencing endoleak following endovascular repair using parallel stent technique for thoracic and abdominal aortic dilatation

doi:10.16139/j.1007-9610.2020.02.012

Abstract

Abstract:

Objective: To analysis the risk factors influencing endoleak following endovascular repair using parallel stent technique for thoracic and abdominal aortic dilation in order to prevent endoleak. Methods: A retrospective analysis was performed on 50 patients with thoracic and abdominal aortic dilation undergoing endovascular repair with parallel stent technique including endoleak group and without endoleak group from January 2011 to March 2018 at Department of Vascular Surgery, Changhai Hospital. The risk factors of endoleak were analyzed. Results: There were 68 parallel stent grafts in this study including 90 chimney stents. Intraoperative angiography found type Ⅰ endoleak in 28 cases (41.2%) and follow up study showed type Ⅰ endoleak in 12 cases (17.6%). There were three factors correlated with endoleak including the ratio of diameter of parallel artery ≥1.44 in vessel, the ratio of diameter of parallel artery ≤1.53 in stent, and parallel between Gore stent and peripheral coated stent according to univariate analysis (P<0.05). Logistic regression analysis showed that the number of parallel stents was an independent factor correlated with endoleak(P<0.05). Conclusions: Diameter matching between parallel stents, the number of parallel stents and stents parallel in vessels or in stent grafts were associated the endoleak of endovascular repair with parallel stent technique for thoracic and abdominal aortic dilatation shown in this study.

Key words: Thoracic and abdominal aortic dilatation, Parallel stent technique, Endoleak

CLC Number:

R654.3

AIKEBAIER Aniwaer, FENG Rui, FENG Jiaxuan, WU Mingwei, ZHAO Yuxi, JING Zaiping. Analysis of factors influencing endoleak following endovascular repair using parallel stent technique for thoracic and abdominal aortic dilatation[J]. Journal of Surgery Concepts & Practice, 2020, 25(02): 146-151.

Figures/Tables 5

References 14

[1]	Best WB, Ahanchi SS, Larion S, et al. Abdominal aortic aneurysm anatomic severity grading score predicts implant-related complications, systemic complications, and mortality[J]. J Vasc Surg, 2016, 63(3):577-584. doi: 10.1016/j.jvs.2015.09.029 URL
[2]	Khashram M, Williman JA, Hider PN, et al. Systematic review and meta-analysis of factors influencing survival following abdominal aortic aneurysm repair[J]. Eur J Vasc Endovasc Surg, 2015, 51(2):203-215. doi: 10.1016/j.ejvs.2015.09.007 URL
[3]	Steuer J, Lachat M, Veith FJ, et al. Endovascular grafts for abdominal aortic aneurysm[J]. Eur Heart J, 2016, 37(2):145-151. doi: 10.1093/eurheartj/ehv593 URL
[4]	曹旭, 张耀中, 秦彦文. 腹主动脉瘤发病机制的研究进展[J]. 心肺血管病杂志, 2012, 31(6):759-761.
[5]	Paravastu SC, Jayarajasingam R, Cottam R, et al. Endovascular repair of abdominal aortic aneurysm[J]. Cochrane Database Syst Rev, 2014,CD004178.
[6]	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. pmid: 14603205
[7]	景在平, 梅志军. 针对腔内隔绝术的主动脉夹层分型的探讨[J]. 中华外科杂志, 2005, 43(13):894-895.
[8]	景在平. 主动脉夹层的诊断和腔内隔绝术应用指南(初稿)[J]. 中国实用外科杂志, 2004, 24(3):129-133.
[9]	Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery[J]. J Vasc Surg, 1991, 13(3):452-458. pmid: 1999868
[10]	Shang EK, Nathan DP, Sprinkle SR, et al. Peak wall stress predicts expansion rate in descending thoracic aortic aneurysms[J]. Ann Thorac Surg, 2013, 95(2):593-598. doi: 10.1016/j.athoracsur.2012.10.025 pmid: 23245445
[11]	Knepper J, Upchurch GR. A review of clinical trials and registries in descending thoracic aortic aneurysms[J]. Semin Vasc Surg, 2010, 23(3):170-175. doi: 10.1053/j.semvascsurg.2010.05.005 pmid: 20826294
[12]	Elkouri S, Martelli E, Gloviczki P, et al. Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts[J]. Vasc Endovascular Surg, 2004, 38(5):401-412. doi: 10.1177/153857440403800502 URL
[13]	XiaoHui M, Wei G, ZhongZhou H, et al. Endovascular repair with chimney technique for juxtarenal aortic aneurysm: a single center experience[J]. Eur J Endovasc Surg, 2015, 49(3):271-276. doi: 10.1016/j.ejvs.2014.11.012 URL
[14]	Tran K, Ullery BW, Itoga N, et al. Polar orientation of renal grafts within the proximal seal zone affects risk of early type IA endoleaks after chimney endovascular aneury-sm repair[J]. J Vasc Surg, 2018, 67(4):1034-1041. doi: 10.1016/j.jvs.2017.08.059 URL

指标	内漏	无内漏	内漏发生率(%)	P值
平行支架数（枚） ①1 ②2 ③3	20 8 0	27 12 1	42.6 40.0 0	0.574
平行支架重叠长度(mm) >35 ≤35	17 11	23 17	42.5 39.3	0.791
支架大小差异大小	20 8	31 9	39.2 47.1	0.569
平行支架方向顺逆	21 7	33 7	38.9 50.0	0.452
平行支架部位血管内平行支架内平行	9 19	15 25	37.5 43.2	0.649
主体支架品牌 Gore（a） Medtronic(b) Micro port (c)	20 3 5	31 3 6	39.2 50.0 45.5	0.703(ac) 0.613(ab) 0.627(bc)
平行支架位置 V3区（a） N3C区（b） N3I区（c）	14 5 9	22 7 11	38.9 41.7 45.0	0.865(ab) 0.434(ac) 0.574(bc)

指标	内漏（n=9）	无内漏（n=15）	内漏发生率(%)	P值
动脉口径比值 <1.44 ≥1.44	6 3	2 13	75 18.75	0.021^a)
主体支架品牌 Gore（a）微创(b) Medtronic(c)	4 4 1	13 0 2	23.5 100 33.3	0.012^a)(ab) 0.601(ac) 0.143(bc)
V3区血管内平行方向顺逆	7 2	13 2	35 50	0.576
肾单烟囱顺方向肾双烟囱顺方向	4 3	8 4	33.3 42.9	0.679
V3区血管内平行支架重叠长度(mm) 25~60 10~24	3 6	7 8	25 40	0.418
V3区肾单烟囱肾双烟囱	6 3	10 4	37.5 42.9	0.809
肾单烟囱顺方向肾单烟囱逆方向	4 2	8 2	33.3 50	0.555

影响因素	内漏（n=19）	无内漏（n=25）	内漏发生率(%)	P值
动脉口径比值 ≤1.53 >1.53	7 12	17 8	29.2 60	0.04^a)
主体支架品牌 Gore(a) Micro port(b) Medtronic(c)	16 1 2	18 6 1	47.1 14.3 66.6	0.207(ab) 0.604(ac) 0.183(bc)
平行支架方向顺逆	14 5	20 5	41.1 50	0.279
支架大小差异大小	11 8	16 9	40.7 47.1	0.76
V3区支架内平行重叠长度(mm) 45~86 30~44	1 4	4 3	20 57.1	0.293
V3区血管内平行支架内平行	9 5	15 7	37.5 41.7	0.809
N3区主体支架品牌 Gore(a) 微创(b)	13 0	12 5	52 0	0.052(ab) 0.741(ac)
Medtronic(c)	1	1	50	0.286(bc)

影响因素	B	偏差	标准误	P值	95% CI
支架数目	20.378	-0.348	0.825	0.019^a)	19.914~20.605
支架重叠长度	-0.092	-0.266	0.646	0.870	-1.261~0.455
支架大小差异	1.024	0.311	0.737	0.130
平行支架方向	-0.660	-0.443	3.237	0.315	-19.097~0.996
主体支架品牌	0.171	-0.095	0.753	0.759	-1.333~1.406