Abstract

 

OBJECTIVES

The aim of this study was to report the outcomes of open or hybrid repair of failed thoraco-abdominal aortic aneurysm endovascular treatment with Multilayer Flow Modulator (MFM) stents.

METHODS

All patients who underwent open or hybrid repair of a failed MFM aortic treatment were retrospectively analysed. Perioperative and postoperative data, as well as midterm survival, were assessed.

RESULTS

Between 2013 and 2020, 39 patients received an open or hybrid conversion after endovascular treatment. Five of them [13%; 4 males; median age 68 years (interquartile range 66–76)] were previously treated with aortic MFM stents (Cardiatis, Isnes, Belgium). Among these, the median interval between index repair and conversion was 84 months (interquartile range 75–84). The median aneurysm diameter was 9.6 cm (interquartile range 8–10). Renovisceral vessels steno-occlusion was highly prevalent: 2 renal arteries were occluded; 3 coeliac trunks, 2 renal arteries and 1 superior mesenteric artery had a >70% ostial stenosis. Open standard thoraco-abdominal aneurysm conversion was performed in 3 fit patients, while a hybrid approach with visceral debranching and tube endografting was performed in 2 high-risk patients. Two patients (2 open repairs) died intraoperatively, and 1 (hybrid repair) postoperatively. The 2 successfully treated patients are alive at 4- and 34-month follow-up, respectively, with patent visceral branches.

CONCLUSIONS

Open or hybrid thoraco-abdominal aortic aneurysm treatment after failed endovascular aortic repair with MFM stents might be the only surgical option to address sac enlargements and ruptures or branch-related failures. However, both procedures had a poor prognosis due to both the impaired preoperative patient’s status and the surgical complexity in the presented series.

中文翻译：

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胸腹动脉瘤多层流量调节器支架植入失败的晚期手术转换

摘要

 

目标

本研究的目的是报告使用多层流量调节器 (MFM) 支架对失败的胸腹主动脉瘤血管内治疗进行开放式或混合式修复的结果。

方法

回顾性分析了对失败的 MFM 主动脉治疗进行开放或混合修复的所有患者。评估了围手术期和术后数据以及中期生存率。

结果

2013 年至 2020 年间，39 名患者在血管内治疗后接受了开放或混合转换。其中五个 [13%; 4名男性；中位年龄 68 岁（四分位距 66-76）] 之前接受过主动脉 MFM 支架（Cardiatis，Isnes，Belgium）。其中，指数修复和转换之间的中位间隔为 84 个月（四分位距 75-84）。中位动脉瘤直径为 9.6 厘米（四分位距 8-10）。肾内脏血管狭窄闭塞非常普遍：2条肾动脉闭塞；3 条腹腔干、2 条肾动脉和 1 条肠系膜上动脉的开口狭窄>70%。在 3 名健康患者中进行了开放标准胸腹动脉瘤转换，而在 2 名高危患者中进行了内脏脱支和管内移植的混合方法。2 例患者（2 例开放修复）术中死亡，1 例（混合修复）术后死亡。2 名成功治疗的患者分别在 4 个月和 34 个月的随访中存活，内脏分支未闭。

结论

在使用 MFM 支架进行血管内主动脉修复失败后，开放或混合胸腹主动脉瘤治疗可能是解决囊肿大和破裂或分支相关失败的唯一手术选择。然而，由于术前患者的状态受损和本系列手术的复杂性，这两种手术的预后都很差。