Postdissection thoracoabdominal aortic aneurysm presenting with narrow true lumen: Outcomes after fenestrated and branched endovascular repair from the international multicenter NArrow-true-lumen DIssection Registry (NADIR) study group.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Piazza Michele, Marrocco Simona, Kölbel Tilo, Tsilimparis Nikolaos, Haulon Stephan, Oderich Gustavo S, Schanzer Andres, Melissano Germano, Kahlberg Andrea, Austermann Martin, Usai Marco V, Mani Kevin, Pratesi Giovanni, Gargiulo Mauro, Gallitto Enrico, Bosiers Michel J, Veraldi Gian Franco, Mezzetto Luca, Bertoglio Luca, Pulli Raffaele, Mansour Wassim, Dias Nuno, Branzan Daniela, Parlani Gianbattista, Giudice Rocco, Ferrer Ciro, Yeung Kak Khee, Tinelli Giovanni, Tshomba Yamume, Rohlffs Fiona, Aru Roberto G, Modarai Bijan, Abdelhalim Mohamed, Nana Petroula, Panuccio Giuseppe, Apostolidis George, Schmid Bruno, Medina Sara, Simonte Gioele, Isernia Giacomo, Bastianon Martina, Melloni Andrea, Dioni Pietro, Favia Nicola, Ascione Marta, Kappe Kaj, Salicilar Erin, Mohammed Yasir, Berczeli Marton, Knappich Cristoph, Karelis Angelos, Bonvini Stefano, Al-Haj Bachar, Colacchio Elda C, Amvrazi Alexia-Vasiliki, Rahman Rafiur, Spertino Andrea, Antonello Michele, Squizzato Francesco
Аннотация
METHODS: Data from an international, multicenter registry were analyzed, to identify patients treated for PD-TAAAs (2015-2025) at 23 centers. All patients underwent fenestrated-branched endovascular repair using custom or off-the-shelf endografts. NTL was defined by a true lumen diameter <25 mm identified at any aortic level on preoperative computed tomography angiogram. Short-term endpoints compared between NTL and no-NTL patients included technical success, procedural metrics, 30-day mortality, and major adverse events (MAEs). Midterm endpoints included 5-year freedom from aortic adverse events (related mortality, rupture, reintervention, endograft instability) and freedom from target artery instability.
RESULTS: Among 544 patients (1705 target vessels), 438 (80%) had an NTL. Device design did not differ between groups (52% branches, 30% fenestrated, and 18% fenestrated-branched combination; P = .053). Patients with an NTL more frequently received bridging stent reinforcement (P < .001), and renal inner branches (P = .038). Septotomy or false lumen occlusion were more often performed in NTLs (27% vs 11%; P = .006). Patients with NTLs had longer operating time (P = .031), fluoroscopy time (P = .007), and a higher dose area product (P = .046). Technical success was 95% in both groups (P = .750). Overall 30-day mortality was 4%, and MAEs occurred in 35%. NTLs did not have a significant impact on MAEs (adjusted odds ratio, 0.84; 95% confidence interval [CI], 0.28-2.76; P = .766). Freedom from any aortic adverse event at 5 years was lower in patents with NTL (73% vs 91%; P = .027), driven primarily by secondary procedures of false lumen embolization (P = .027). Freedom from target vessel instability was 86% ± 4% in the NTL group and 92% ± 4% in the no-NTL group (P = .072). Patients with NTLs had a similar primary patency (97% ± 2% vs 98% ± 2%; P = .380) but lower freedom from target vessel endoleak (89% ± 4% vs 97% ± 3%; P = .006). After adjustment, NTL diameter <10 mm (hazard ratio [HR], 2.45; 95% CI, 1.37-4.36; P = .002) was significantly associated with target artery instability. Use of inner branches (HR, 0.11; 95% CI, 0.02-0.87; P = .035) and bridging stent reinforcement (HR, 0.54; 95% CI, 0.31-0.96; P = .038) were protective.
CONCLUSIONS: NTL is the most common anatomic presentation in PD-TAAAs and is associated with more complex procedures, but does not affect technical success, mortality, or MAEs. Patients with an NTL experience a higher rate or reinterventions, primarily false lumen embolization. NTL <10 mm is a risk factor for target vessel instability, and reinforcement of bridging stents may be beneficial in these cases.