Adjunctive Iliac Stents Reduce the Risk of Stent-Graft Limb Occlusion Following Endovascular Aneurysm Repair With the Zenith Stent-Graft
| Autor: | Richard G. McWilliams, John A. Brennan, Leith A. Williams, Olufemi A. Oshin, S. Rao Vallabhaneni, G.L. Gilling-Smith, Robert K. Fisher |
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| Rok vydání: | 2010 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Aortography medicine.medical_treatment Kaplan-Meier Estimate Prosthesis Design Iliac Artery Risk Assessment Endovascular aneurysm repair Blood Vessel Prosthesis Implantation Risk Factors Blood vessel prosthesis Occlusion medicine Humans Radiology Nuclear Medicine and imaging Aged Retrospective Studies Aged 80 and over Chi-Square Distribution medicine.diagnostic_test business.industry Graft Occlusion Vascular Stent Retrospective cohort study Middle Aged medicine.disease Abdominal aortic aneurysm Blood Vessel Prosthesis Surgery Treatment Outcome Angiography Female Stents Radiology Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Aortic Aneurysm Abdominal |
| Zdroj: | Journal of Endovascular Therapy. 17:108-114 |
| ISSN: | 1545-1550 1526-6028 |
| DOI: | 10.1583/09-2854.1 |
| Popis: | To determine whether the introduction of a policy of adjunctive stent insertion based on preoperative CT assessment or completion angiography reduced the incidence of limb occlusion after stent-graft implantation for endovascular aneurysm repair (EVAR).A tertiary referral unit's endovascular database was retrospectively interrogated to compare the incidence of endograft limb occlusion in Zenith grafts following the introduction of a policy of selective adjunctive stent insertion. Group A included 288 limbs at risk in 146 patients (134 men; mean age 74+/-8 years) treated prior to August 2005 in whom adjunctive stents were inserted on an ad hoc basis only. Group B included 293 limbs at risk in 149 patients (127 men; mean age 76+/-7 years) treated after this date in whom a more aggressive adjunctive stenting strategy was adopted. Kaplan-Meier analysis was employed to compare outcomes.In total, 295 patients underwent EVAR involving 581 iliac vessels, of which 11 (1.8%) occluded at a median of 24 months (0-27). Of 65 limbs extended into the external iliac segment, 5 (7.6%) subsequently occluded; in the remaining 516 limbs, there were 6 (1.1%) occlusions (p = 0.004). Across the study group, 38 (6.5%) adjunctive stents were deployed in limbs deemed at risk; 1 (2.6%) of these occluded. In the remaining 543 unstented limbs, 10 (1.8%) occlusions occurred (p = 0.15). There were 11 occlusions in group A, in which 5 (1.7%) adjunctive stents had been deployed, but none in group B, which had received 33 (11.2%) stents (p0.0001). Kaplan-Meier survival curves identified primary patency rates at 36 months of 96% and 100%, respectively (p = 0.001).Adjunctive stenting significantly reduces the risk of postoperative stent-graft limb occlusion without obvious compromise to the aneurysm repair. |
| Databáze: | OpenAIRE |
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