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Der PALMAZ®-XL-Stent zur Behandlung von proximalen Endoleaks nach endovaskulärem Repair infrarenaler Aortenaneurysmen

EVAR beim AAA mit „hostile neck“ – Möglichkeiten und Grenzen

PALMAZ® XL stent for treatment of proximal endoleaks after endovascular repair of infrarenal aortic aneurysms

EVAR in AAA with hostile neck – possibilities and limits

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Zusammenfassung

Hintergrund

Die erfolgreiche Behandlung infrarenaler abdomineller Aortenaneurysmen (AAA) mit einer endovaskulären Stentprothese (EVAR) hängt im besonderen Maße von einer guten Apposition der Prothese an die Aortenwand ab. Bei proximalen Endoleaks (EL) kann durch eine Andilatation der proximalen Attachmentzone mit einem PALMAZ®-XL-Stent (Cordis, Diegem, Belgium) eine Abdichtung erreicht werden.

Ziel

In dieser Arbeit sollen die eigenen Ergebnisse und ein Überblick der Literatur von dieser Methode vorgestellt werden.

Material und Methoden

In dieser retrospektiven Analyse wurden neun konsekutive Patienten (Median 78 Jahre) eingeschlossen, bei denen im Rahmen einer EVAR-Implantation bei AAA ein primäres EL Typ Ia auftrat (02/2008–03/2013) und mit einem PALMAZ®-XL-Stent versorgt wurden. Zusätzlich wurde eine PubMed Recherche mit den Suchworten „aortic aneurysm“, „endoleak“, „endovascular“ und „palmaz stent“ durchgeführt.

Ergebnisse

Die PALMAZ®-XL-Stentimplantation zeigte eine technische Erfolgsrate von 90 % (1-mal Stentdislokation) mit einer suffizienten Ausschaltung aller EL Typ Ia (100 %). Der Median des Nachbeobachtungszeitraums betrug 23 Monate (2–36 Monate). In dieser Zeit kam es zu keinem CT-angiographisch erneuten Auftreten eines EL Typ Ia und somit auch zu keiner erneuten Reintervention.

In der PubMed-Recherche konnten insgesamt drei relevante Artikel mit 77 Patienten identifiziert werden. Die kumulative technische Erfolgsrate der Stentimplantation betrug 99 % (77/78) mit einer Abdichtungsrate der EL von ebenfalls 99 % (76/77).

Diskussion

Die Implantation eines PALMAZ®-XL-Stents stellt eine kostengünstige und dauerhafte Methode bei EL Typ Ia nach EVAR Implantation dar.

Abstract

Background

Successful treatment of infrarenal abdominal aortic aneurysms (AAA) with endovascular aneurysm repair (EVAR) stent prostheses is particularly dependent on a good apposition of the prosthesis to the aortic wall. Proximal endoleaks (EL) can be resolved by dilatation of the EVAR at the proximal attachment zone with a PALMAZ® XL (Cordis, Diegem, Belgium) stent.

Objectives

This article presents own results and an overview of the literature about this method.

Methods

A total of nine consecutive patients (median age 78 years) who were treated with a PALMAZ® XL stent due to a primary type Ia EL after EVAR implantation (from February 2008 to March 2013) were included in this retrospective analysis. In addition a PubMed search with the keywords “aortic aneurysm”, “endoleak”, “endovascular” and “palmaz stent” was carried out.

Results

The PALMAZ® XL stent implantation showed a technical success rate of 90 % (one dislocation of stent) with a sufficient elimination of all type Ia ELs (100 %). The median follow-up time was 23 months (range 2–36 months). Within the follow up interval no recurrent type Ia EL was found in the control computed tomography (CT) angiographies and therefore no reinterventions were needed. The PubMed search revealed 3 relevant articles reporting on 77 patients. The technical success rate was 99 % (77 out of 78) and the treatment success rate was also 99 % (76 out of 77).

Discussion

In conclusion, implantation of a PALMAZ® XL stent is a cost-efficient and durable method to treat type Ia ELs after EVAR implantation.

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Literatur

  1. Greenhalgh RM et al (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362:1863–1871

    Article  PubMed  Google Scholar 

  2. Lederle FA et al (2009) Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 302:1535–1542

    Article  CAS  PubMed  Google Scholar 

  3. Lovegrove RE et al (2008) A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg 95:677–684

    Article  CAS  PubMed  Google Scholar 

  4. Sicard GA et al (2006) Endovascular abdominal aortic aneurysm repair: long-term outcome measures in patients at high-risk for open surgery. J Vasc Surg 44:229–236

    Article  PubMed  Google Scholar 

  5. Leurs LJ et al (2006) Influence of infrarenal neck length on outcome of endovascular abdominal aortic aneurysm repair. J Endovasc Ther 13:640–648

    Article  PubMed  Google Scholar 

  6. Malina M, Resch T, Sonesson B (2008) EVAR and complex anatomy: an update on fenestrated and branched stent grafts. Scand J Surg 97:195–204

    CAS  PubMed  Google Scholar 

  7. Antoniou GA et al (2013) A meta-analysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy. J Vasc Surg 57:527–538

    Article  PubMed  Google Scholar 

  8. Abbruzzese TA et al (2008) Outcomes following endovascular abdominal aortic aneurysm repair (EVAR): an anatomic and device-specific analysis. J Vasc Surg 48:19–28

    Article  PubMed  Google Scholar 

  9. Aburahma AF et al (2011) Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices. J Vasc Surg 54:13–21

    Article  PubMed  Google Scholar 

  10. Choke E et al (2006) Outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile neck anatomy. Cardiovasc Intervent Radiol 29:975–980

    Article  PubMed  Google Scholar 

  11. Fairman RM et al (2004) Midterm pivotal trial results of the Talent Low Profile System for repair of abdominal aortic aneurysm: analysis of complicated versus uncomplicated aortic necks. J Vasc Surg 40:1074–1082

    Article  PubMed  Google Scholar 

  12. Fulton JJ et al (2006) Effect of challenging neck anatomy on mid-term migration rates in AneuRx endografts. J Vasc Surg 44:932–937

    Article  PubMed  Google Scholar 

  13. Hoshina K et al (2011) Middle-term results of endovascular aneurysm repair in Japan: does intraoperative endovascular management against the hostile aneurysmal neck prevent the proximal type I endoleak? Int Angiol 30:467–473

    CAS  PubMed  Google Scholar 

  14. Torsello G et al (2011) Evaluation of the Endurant stent graft under instructions for use vs off-label conditions for endovascular aortic aneurysm repair. J Vasc Surg 54:300–306

    Article  PubMed  Google Scholar 

  15. http://www.cordis.com/emea/tn/product/palmaz-genesis-peripheral-stent. Zugegriffen: 3. Jan. 2014

  16. Kim JK et al (2008) A technique for increased accuracy in the placement of the „giant“ Palmaz stent for treatment of type IA endoleak after endovascular abdominal aneurysm repair. J Vasc Surg 48:755–757

    Article  PubMed  Google Scholar 

  17. Arthurs ZM et al (2011) Long-term outcomes of Palmaz stent placement for intraoperative type Ia endoleak during endovascular aneurysm repair. Ann Vasc Surg 25:120–126

    Article  PubMed  Google Scholar 

  18. Farley SM et al (2011) A retrospective review of Palmaz stenting of the aortic neck for endovascular aneurysm repair. Ann Vasc Surg 25:735–739

    Article  PubMed  Google Scholar 

  19. Rajani RR et al (2011) Repairing immediate proximal endoleaks during abdominal aortic aneurysm repair. J Vasc Surg 53:1174–1177

    Article  PubMed  Google Scholar 

  20. Byrne J et al (2013) Does Palmaz XL stent deployment for type 1 endoleak during elective or emergency endovascular aneurysm repair predict poor outcome? A multivariate analysis of 1470 patients. Ann Vasc Surg 27:401–411

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. PD Dr. A. Zimmermann erhielt Studien- und Reisekostenunterstützungen sowie Honorare für Vorträge von den Firmen ev3 GmbH, C.R. Bard GmbH, Philips GmbH, Medtronic GmbH und Gore & Associates GmbH. C. Reeps, M. Kallmayer und H.-H. Eckstein geben an, dass kein Interessenkonflikt besteht.

Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland

    A. Zimmermann, C. Reeps, M. Kallmayer &  H.-H. Eckstein

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  1. A. Zimmermann
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  2. C. Reeps
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  3. M. Kallmayer
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  4. H.-H. Eckstein
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Correspondence to H.-H. Eckstein.

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Zimmermann, A., Reeps, C., Kallmayer, M. et al. Der PALMAZ®-XL-Stent zur Behandlung von proximalen Endoleaks nach endovaskulärem Repair infrarenaler Aortenaneurysmen. Gefässchirurgie 19, 200–204 (2014). https://doi.org/10.1007/s00772-013-1273-y

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