RESUMEN
El objetivo de este estudio ha sido evaluar mediante modelos in vitro, dos configuraciones distintas de stent paralelo: en 2 y 3 chimeneas viscerales (chEVAR) y en configuración tipo sándwich para preservar la arteria hipogástrica y analizar cuál es la mejor combinación de materiales, el grado óptimo de sobredimensión y la mejor técnica de medición de esta última. Respecto a la configuración en 2-3 chimeneas, los resultados mostraron una mejor adaptación general de los componentes a sobredimensiones crecientes con una menor tasa de compresión en las combinaciones de alta fuerza radial aunque a expensas de un significativo peor sellado. Respecto a la configuración en sándwich, los resultados mostraron también una reducción de las zonas de mal sellado a mayor sobredimensión aunque a expensas de una mayor compresión y de un mayor replegado, sin diferencias significativas con los distintos dispositivos utilizados. Respecto a la medición de la sobredimensión, se obtuvo una correlación prácticamente perfecta entre la sobredimensión de áreas (clásicamente descrita) con la de perímetros y de diámetros. En conclusión, los resultados de este estudio in vitro pueden ser de utilidad en la planificación de procedimientos reales de EVAR con stent paralelo ante la ausencia de evidencia actual que soporte unas recomendaciones específicas.(AU)
The aim of this study was evaluate using in vitro models, two different configurations of parallel stenting: 2 and 3 visceral chimneys (chEVAR) and in a sandwich configuration to preserve the hypogastric artery, analysing which is the best combination of materials, the optimal oversizing and the best measurement method. Regarding 2-3 chimney configuration, our results showed a better adaptation of the devices with increasing oversizing with a lower compression rate in high radial force combinations, although with a significantly worse sealing. Regarding sandwich configuration, our results also showed gutter area reduction when increasing oversizing although higher compression rate and inflodin, without significant differences between the devices used. Regarding oversizing measuring methods, a practically perfect correlation was obtained between area oversizing (classically described) and perimeter and diameter oversizing. In conclusion, the results of this in vitro study may be useful in planning real EVAR procedures with parallel stenting in the absence of current evidence to support specific recommendations.(AU)
Asunto(s)
Humanos , Stents , Aorta Abdominal , Aneurisma de la Aorta Abdominal , Prótesis e Implantes , 28573 , Sistema CardiovascularRESUMEN
OBJECTIVE: Branched and fenestrated endografts (fEVAR/bEVAR) are complex techniques used to treat thoracic aorta pathologies involving the aortic arch. This systematic review aims to determine all the reported results regarding these techniques in the aortic arch, in order to describe their clinical outcomes. METHODS: A systematic review of the literature was performed, considering all articles published until October 2019. PubMed, Cochrane database resources were used. The protocol of the study was previously registered in the Prospero database (CRD42020147037). Primary exclusion criteria included opinion articles, merely technique descriptions, articles without the follow-up of at least 1 month, studies conducted on animals, mixed treatments, and ongoing trials without published data. Included variables were study design, aortic pathology, type of endovascular technique (fEVAR/bEVAR), endograft manufacturing, number of fenestrations/branches and type of bridge stents. Technical success, complications during surgery and follow-up were also described. RESULTS: From a total of 164 articles, 29 (28 retrospective, 1 prospective) were analyzed with a total of 693 cases (341 fEVAR and 352 bEVAR). The most common indications for repair were aneurysm (54.8%) and dissection (40%). Only fEVAR and bEVAR were considered, but different endograft materials and techniques were used and, therefore, reported upon in the current review. Zenith Alpha Thoracic Endovascular Graft was the most representative (24% of cases). Custom made, off-the-shelf, physician modified and in situ fenestrated endografts were also used in 39%, 22.4%, 18.6% and 18.9% of cases, respectively. Bridge stents were implanted in the 50.5% of cases. Technical success rate was 96%. The main intraoperative complication was the endoleak (5.2%) followed by stroke (4.8%). The in-hospital mortality was 2.5%. The mean follow-up was 18.5 months. The mortality related to the main operation during follow-up was 3.2% and not directly related to the main operation was 11.3%. During the follow-up, 92 cases (13.3%) in total had to undergo through a reintervention, 46.7% with endovascular repair and 26.1% with open surgical repair (the rest were not specified). CONCLUSION: published experience with bEVAR and fEVAR in the aortic arch showed acceptable short-term effectiveness and safety. More well-conducted prospective clinical studies with long term follow-up, combined with comparative meta-analysis, are needed to elucidate the real benefit of those endovascular techniques in the aortic arch pathology.