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首页> 外文期刊>Vascular and endovascular surgery >Is neck dilatation after endovascular aneurysm repair graft dependent? Results of 4 US Phase II trials.
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Is neck dilatation after endovascular aneurysm repair graft dependent? Results of 4 US Phase II trials.

机译：血管内动脉瘤修复后的颈部扩张是否依赖移植？ 4个美国II期试验的结果。

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Long-term success of endovascular aneurysm repair (EVAR) relies on a stable proximal neck. The authors' goal was to determine whether neck dilatation after EVAR varies among 4 different endografts and whether it is related to complications of the proximal neck. Core laboratory data from 4 phase II trials of aortic endografts were analyzed for neck diameter changes over time. Patients who had at least 24 months' follow-up were included in the analysis. Neck measurement methodology varied among the 3 core labs used. Values are reported within the parameters used by each lab. Short-axis neck diameter close to 5 mm below the renal arteries, when available, was used for longitudinal comparisons. Dilation was defined as an enlargement of 3 mm or more from the first postoperative scan to the last available follow-up for each patient. Graft migration and late proximal endoleaks were determined by the individual core labs. A limited number of Lifepath grafts had most recent follow-up measurements performed by the authors. Results were compared by using Student's t test, chi-square analysis, and the Pearson correlation coefficient. Postoperative measurements from 729 EVAR patients were examined. Follow-up ranged from 24 to 60 months for 229 Ancure (Guidant) and 258 AneuRx (Medtronic) patients, and from 24 to 36 months for 211 Excluder (Gore) and 31 first-generation Lifepath (Edwards) patients. Neck dilation was noted in 124 patients (17.0%) and did not differ significantly among graft types. The incidences of late proximal endoleaks were similar among graft types, but rates of migration differed (p=0.01). Dilation was associated with migration in Ancure (p=0.03) and Excluder (p=0.02) grafts. Late proximal endoleaks were seen in 4.1% of patients with and in 0.7% of patients without dilation (p=0.001). Patients with initial neck diameter >25 mm had significantly less dilatation than those with smaller necks (p<0.001). The incidence of neck dilation approached 20% in all EVAR patients after 24 months and was not significantly different among graft types. Neck dilation of 3 mm or more appears to be one risk factor for migration and late proximal endoleak.
机译：血管内动脉瘤修复（EVAR）的长期成功取决于稳定的近端颈部。作者的目标是确定EVAR后颈部扩张是否在4种不同的内移植物中有所不同，以及是否与近端颈部并发症有关。分析了来自4个主动脉内移植II期临床试验的核心实验室数据，以了解颈部直径随时间的变化。该分析包括至少随访24个月的患者。在所使用的三个核心实验室中，颈部测量方法各不相同。在每个实验室使用的参数内报告值。如果可以的话，将短轴颈直径接近肾动脉以下5毫米，用于纵向比较。扩张定义为每位患者从首次术后扫描到最后一次可用随访扩大3 mm或更多。移植物的迁移和近端晚期内漏由各个核心实验室确定。有限数量的Lifepath移植物由作者进行了最新的随访测量。使用学生t检验，卡方分析和皮尔森相关系数比较结果。检查了729名EVAR患者的术后测量结果。 229位Ancure（Guidant）和258位AneuRx（Medtronic）患者的随访时间为24至60个月，211位Excluder（Gore）和31位第一代Lifepath（Edwards）患者的随访时间为24至36个月。在124例患者中发现颈部扩张（17.0％），并且在移植物类型之间没有显着差异。在移植物类型之间，近端近端内漏的发生率相似，但是迁移率不同（p = 0.01）。扩张与Ancure（p = 0.03）和Excluder（p = 0.02）移植物中的迁移有关。在有扩张的患者中有4.1％的患者发生了晚期近端内渗，在没有扩张的患者中有0.7％（p = 0.001）。初始颈部直径> 25 mm的患者的扩张明显少于较小颈部的患者（p <0.001）。 24个月后，所有EVAR患者的颈部扩张发生率均接近20％，并且移植物类型之间无显着差异。 3 mm或更大的颈部扩张似乎是迁移和晚期近端内漏的危险因素之一。

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