腹主动脉瘤腔内修复术后形态学研究
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摘要
目的:回顾性观察腹主动脉瘤(Abdominal Aortic Aneurysm AAA)腔内修复(endovascular repair EVR)术后瘤体直径变化、近端瘤颈直径变化、支架型血管主体向远端移位,并分析影响因素。
方法:对45例有完整术前计算机断层扫描(Computed tomography CT)资料并接受EVR,且6个月以上的定期(术后1、3、6、12月及以后每年)增强CT随访的AAAs患者进行回顾分析。通过CT观察术后瘤体直径变化、近端瘤颈直径变化及支架型血管主体向远端移位,分别以5mm、2mm和5mm为有变化,不足5mm和2mm时为无变化,并分析与支架型血管相关和与病人相关的的影响因素。经CT检查内漏发生情况。
结果:平均随访时间34.5±24.8个月(9～100个月)。
(1)平均术前瘤体直径51.9±9.7mm(30～82mm),术后瘤体直径47.9±13.2mm(26.2～78.8mm),平均瘤体直径变化-4.0±8.3mm(-23.8～11mm)。瘤体直径增加15.6%,增加10mm以上4.5%;瘤体直径减小40%;瘤体直径不变44.5%。术中Ⅰ型内漏8例(17.8%),Ⅱ型内漏12例(26.7%)。术后24个月瘤体减少5mm及以上发生率为37.6%,31个月为53.4%,96个月时89.7%。
(2)平均术前瘤颈直径为21.54±2.3mm;术后一月瘤颈22.444±2.36mm,最近一次瘤颈直径24.04±2.82mm。瘤颈增71.1%。所选支架较术前瘤颈增大百分比(oversizing percentage OP)18.94±6.10%。瘤颈直径大于支架标定型号6.7%。16个月无瘤颈扩张率为97.4%,24个月时无瘤颈扩张率为68.6%,36个月无瘤颈扩张为39.3%,96个月时无瘤颈扩张率为3.3%(2例)。
(3)移位率22%,平均距离7.04±1.32mm(0～9.5mm),无移位10mm以上者,没有因为移位需要进行二次治疗者。28个月时无移位率为87.5%,66个月时无移位率为64.2%,82个月时无移位率为32.1%,96个月时无移位率为16%。
结论:
(1)术中内漏对术后瘤体变化影响不明显。术后持续性Ⅱ型漏、迟发和再发Ⅰ型漏可能促进瘤体增加。
(2)OP值越大,术后一个月瘤颈扩张越多。
(3)支架型血管的移位与中远期瘤颈扩张有相互促进作用。
(4)跨肾动脉固定对术后移位发生率减低有关
Objective:To review the diameter change in Abdominal Aortic Aneurysm(AAA), aneurysm neck diameter change and device migration after endovascular repair (EVR)of AAA and analyze the factors related to these changes.
Methods:The completely preoperative CT of forty-five patients with AAAs who underwent EVR and followed up longer than 6 months at regular intervals were reviewed retrospectively.The follow-up program was contrast-enhanced CT at 1, 3,6,12 months and annually thereafter.The diameter change in AAA,aneurysm neck diameter change and device migration were reviewed respectively,and 5mm, 2mm,5mm were defined as a significant change correspondingly.No changes was defined as less than 5mm and 2mm.The patient-related and stent-graft-related factors were analyzed.The status of endoleak was detected by CT.
Results:The average follow-up interval was 34.5±24.8 months(range, 9～100mon).
(1)Aneurysm sac diameter changed from 51.9±9.7mm(range,30～82mm) preoperatively to 47.9±13.2mm(26.2～78.8mm)postoperatively(P＜.05).The mean diameter change was -4.0±8.3mm(-23.8～11mm).The expansion of sac diameter was detected in 15.6%and 4.5%when over-5mm and over-10mm respectively.The decrease of sac diameter was detected in 40%when more than 5mm.The sac diameter had kept stable was detected in 44.5%.There were 20 patients with endoleak intraoperation.Eight of these were type-1 endoleaks and twelve were type-2 endoleaks.The incidence of over-5mm decrease was 37.6%, 53.4%and 89.7%at 24,31 and 96months postoperatively respectively. (2)The mean proximal neck diameter was 21.5±2.3mm,22.44±2.36mm and 24.0±2.82mm at the preoperative,one month after operative and the latest follow-up.The increase of proximal neck diameter was detected in 71.1%.The oversizing percentage(OP)was 18.9±6.10%.The incidence of proximal neck over-sizing stent-graft in diameter was detected in 6.7%.The incidence of no dilation at proximal neck diameter was 97.4%,68.6%,39.3%and 3.3%(2 cases) at 16,24,36 and 96 months postoperatively respectively.
(3)The stent-graft migration was detected in 22%,and was 7.0±1.32mm in average(range,0～9.5mm).There were not cases which the migration oversized 10mm,and no reintervine was necessary.The incidence of no migration was 87.5%,64.2%,32.1%and 16%at 28,66,82 and 96 months postoperatively respectively.
Conclusions:
(1)The intra-procedure endoleak has not significant effect on the change of AAA diameter.The persistent typeⅡendoleak,late and recurrent typeⅠendoleak may influence the expansion of AAA positively.
(2)The more oversizing percentage,the more dilation the proximal neck.
(3)The stent-graft migration and the dilation the proximal neck of median and long term follow-up might have effect on each other.
(4)The suprarenal aortic stent-grafts might have decrease the frequency of migration
方法:对45例有完整术前计算机断层扫描(Computed tomography CT)资料并接受EVR,且6个月以上的定期(术后1、3、6、12月及以后每年)增强CT随访的AAAs患者进行回顾分析。通过CT观察术后瘤体直径变化、近端瘤颈直径变化及支架型血管主体向远端移位,分别以5mm、2mm和5mm为有变化,不足5mm和2mm时为无变化,并分析与支架型血管相关和与病人相关的的影响因素。经CT检查内漏发生情况。
结果:平均随访时间34.5±24.8个月(9～100个月)。
(1)平均术前瘤体直径51.9±9.7mm(30～82mm),术后瘤体直径47.9±13.2mm(26.2～78.8mm),平均瘤体直径变化-4.0±8.3mm(-23.8～11mm)。瘤体直径增加15.6%,增加10mm以上4.5%;瘤体直径减小40%;瘤体直径不变44.5%。术中Ⅰ型内漏8例(17.8%),Ⅱ型内漏12例(26.7%)。术后24个月瘤体减少5mm及以上发生率为37.6%,31个月为53.4%,96个月时89.7%。
(2)平均术前瘤颈直径为21.54±2.3mm;术后一月瘤颈22.444±2.36mm,最近一次瘤颈直径24.04±2.82mm。瘤颈增71.1%。所选支架较术前瘤颈增大百分比(oversizing percentage OP)18.94±6.10%。瘤颈直径大于支架标定型号6.7%。16个月无瘤颈扩张率为97.4%,24个月时无瘤颈扩张率为68.6%,36个月无瘤颈扩张为39.3%,96个月时无瘤颈扩张率为3.3%(2例)。
(3)移位率22%,平均距离7.04±1.32mm(0～9.5mm),无移位10mm以上者,没有因为移位需要进行二次治疗者。28个月时无移位率为87.5%,66个月时无移位率为64.2%,82个月时无移位率为32.1%,96个月时无移位率为16%。
结论:
(1)术中内漏对术后瘤体变化影响不明显。术后持续性Ⅱ型漏、迟发和再发Ⅰ型漏可能促进瘤体增加。
(2)OP值越大,术后一个月瘤颈扩张越多。
(3)支架型血管的移位与中远期瘤颈扩张有相互促进作用。
(4)跨肾动脉固定对术后移位发生率减低有关
Objective:To review the diameter change in Abdominal Aortic Aneurysm(AAA), aneurysm neck diameter change and device migration after endovascular repair (EVR)of AAA and analyze the factors related to these changes.
Methods:The completely preoperative CT of forty-five patients with AAAs who underwent EVR and followed up longer than 6 months at regular intervals were reviewed retrospectively.The follow-up program was contrast-enhanced CT at 1, 3,6,12 months and annually thereafter.The diameter change in AAA,aneurysm neck diameter change and device migration were reviewed respectively,and 5mm, 2mm,5mm were defined as a significant change correspondingly.No changes was defined as less than 5mm and 2mm.The patient-related and stent-graft-related factors were analyzed.The status of endoleak was detected by CT.
Results:The average follow-up interval was 34.5±24.8 months(range, 9～100mon).
(1)Aneurysm sac diameter changed from 51.9±9.7mm(range,30～82mm) preoperatively to 47.9±13.2mm(26.2～78.8mm)postoperatively(P＜.05).The mean diameter change was -4.0±8.3mm(-23.8～11mm).The expansion of sac diameter was detected in 15.6%and 4.5%when over-5mm and over-10mm respectively.The decrease of sac diameter was detected in 40%when more than 5mm.The sac diameter had kept stable was detected in 44.5%.There were 20 patients with endoleak intraoperation.Eight of these were type-1 endoleaks and twelve were type-2 endoleaks.The incidence of over-5mm decrease was 37.6%, 53.4%and 89.7%at 24,31 and 96months postoperatively respectively. (2)The mean proximal neck diameter was 21.5±2.3mm,22.44±2.36mm and 24.0±2.82mm at the preoperative,one month after operative and the latest follow-up.The increase of proximal neck diameter was detected in 71.1%.The oversizing percentage(OP)was 18.9±6.10%.The incidence of proximal neck over-sizing stent-graft in diameter was detected in 6.7%.The incidence of no dilation at proximal neck diameter was 97.4%,68.6%,39.3%and 3.3%(2 cases) at 16,24,36 and 96 months postoperatively respectively.
(3)The stent-graft migration was detected in 22%,and was 7.0±1.32mm in average(range,0～9.5mm).There were not cases which the migration oversized 10mm,and no reintervine was necessary.The incidence of no migration was 87.5%,64.2%,32.1%and 16%at 28,66,82 and 96 months postoperatively respectively.
Conclusions:
(1)The intra-procedure endoleak has not significant effect on the change of AAA diameter.The persistent typeⅡendoleak,late and recurrent typeⅠendoleak may influence the expansion of AAA positively.
(2)The more oversizing percentage,the more dilation the proximal neck.
(3)The stent-graft migration and the dilation the proximal neck of median and long term follow-up might have effect on each other.
(4)The suprarenal aortic stent-grafts might have decrease the frequency of migration
引文
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1. Malas MB, Ohki T, Veith FJ, et al. Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts. J Vasc Surg. 2005; 42(4):639-44.
2. White RA, Donayre CE, Walot I, et al. Computed tomography assessment of abdominal aortic aneurysm morphology after endograft exclusion. J Vasc Surg. 2001; 33(2 Suppl):Sl-10.
3. Sternbergh WC 3rd, Money SR, Greenberg RK, et al. Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith Multicenter Trial. J Vasc Surg. 2004; 39(1):20-6
4. Malas MB, Ohki T, Veith FJ, et al. Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts. J Vasc Surg. 2005; 42(4):639-44
5. Cao P, Verzini F, Parlani G, et al. Predictive factors and clinical consequences of proximal aortic neck dilatation in 230 patients undergoing abdominal aorta aneurysm repair with self-expandable stent-grafts. J Vasc Surg. 2003;
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8. Sampaio SM, Panneton JM, Mozes G, et al. Aortic neck dilation after endovascular abdominal aortic aneurysm repair: should oversizing be blamed? Ann Vasc Surg. 2006; 20(3):338-45.
1. Becquemin JR Kelley L, Zubilewicz T, et al. Outcomes of secondary interventions after abdominal aortic aneurysm endovascular repair. J Vasc Surg 2004; 39:298-305.
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3. Li Z, Kleinstreuer C. Analysis of biomechanical factors affecting stent-graft migration in an abdominal aortic aneurysm model. J Biomech. 2006; 39(12):2264-73.
4. Benharash P, Lee JT, Abilez OJ ,et, al. Iliac fixation inhibits migration of both suprarenal and infrarenal aortic endografts. J Vasc Surg. 2007; 45(2):250-7.
5. Heikkinen MA, Alsac JM, Arko FR, et al. The importance of iliac fixation in prevention of stent graft migration. J Vasc Surg. 2006; 43(6): 1130-7.
6. Tonnessen BH, Sternbergh WC 3rd, Money SR. Mid- and long-term device migration after endovascular abdominal aortic aneurysm repair, a comparison of AneuRx and Zenith endografts. J Vasc Surg. 2005; 42(3):392-400.
7. Lee JT, Lee J, Aziz I.Stent-graft migration following endovascular repair of aneurysms with large proximal necks: anatomical risk factors and long-term sequelae. J Endovasc Ther. 2002; 9(5):652-64.
8. Resch T, Ivancev K, Brunkwall J, et al. Distal migration of stent-grafts after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 1999; 10(3):257-64.
9. Zarins CK, Bloch DA, Crabtree T, et al. Stent graft migration after endovascular aneurysm repair: importance of proximal fixation. J Vasc Surg. 2003; 38(6): 1264-72.
10. Malas MB, Ohki T, Veith FJ, et al. Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts. J Vasc Surg. 2005; 42(4):639-44.
11.Sampaio SM, Panneton JM, Mozes G, et al. AneuRx device migration: incidence, risk factors, and consequences. Ann Vasc Surg. 2005; 19(2): 178-85.
12. Benharash P, Lee JT, Abilez OJ, et al. Iliac fixation inhibits migration of both suprarenal and infrarenal aortic endografts. J Vasc Surg. 2007; 45(2):250-7.
13. Ruppert V, Leurs LJ, Hobo R, et al. Tube stent-grafts for infrarenal aortic aneurysm: a matched-paired analysis based on EUROSTAR data.Cardiovasc Intervent Radiol. 2007; 30(4)611-8.
14. Sternbergh WC 3rd, Money SR, Greenberg RK, et al. Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith Multicenter Trial. J Vasc Surg. 2004; 39(1):20-6.
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17. Mohan IV, Harris PL, Van Marrewijk CJ, et al. Factors and forces influencing stent-graft migration after endovascular aortic aneurysm repair. J Endovasc Ther. 2002; 9(6):748-55.
1. Litwinski RA, Donayre CE, et al. The role of aortic neck dilation and elongation in the etiology of stent graft migration after endovascular abdominal aortic aneurysm repair with a passive fixation device. J Vasc Surg. 2006; 44(6): 1176-81.
2. Ouriel K, Clair DG, Greenberg RK, et al. Endovascular repair of abdominal aortic aneurysms: Device-specific outcome. J Vasc Surg. 2003; 37:991-998
3. Resch T, Ivancev K, Brunkwall J, et al. Distal migration of stent-grafts after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 1999; 10(3):257-64; discussion 265-6.
4. Tonnessen BH, Sternbergh WC 3rd, Money SR. Mid- and long-term device migration after endovascular abdominal aortic aneurysm repair: a comparison of AneuRx and Zenith endografts. J Vasc Surg. 2005; 42(3):392-400.
5. Zarins CK, Bloch DA, Crabtree T, et al. Stent graft migration after endovascular aneurysm repair: importance of proximal fixation. J Vasc Surg. 2003; 38(6): 1264-72; discussion 1272.
6. Malas MB, Ohki T, Veith FJ, et al. Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts. J Vasc Surg. 2005; 42(4):639-44.
7. Dalainas I, Nano G, Bianchi P, et al. Aortic neck dilatation and endograft migration are correlated with self-expanding endografts. J Endovasc Ther. 2007; 14(3)318-23.
8. Greenberg RK, Deaton D, Sullivan T, et al. Variable sac behavior after endovascular repair of abdominal aortic aneurysm: analysis of core laboratory data. J Vasc Surg. 2004; 39(1):95-101.
9. Heikkinen MA, Alsac JM, Arko FR, et al. The importance of iliac fixation in prevention of stent graft migration. J Vasc Surg. 2006 Jun;43(6):l 130-7.
10. Sampaio SM, Panneton JM, Mozes G, et al. AneuRx device migration: incidence, risk factors, and consequences. Ann Vasc Surg. 2005; 19(2): 178-85.
11. Lee JT, Lee J, Aziz I, et al. Stent-graft migration following endovascular repair of aneurysms with large proximal necks: anatomical risk factors and iong-term sequelae. J Endovasc Ther. 2002; 9(5):652-64.
12. Harris PL, Vallabhaneni SR, Desgranges P, et al. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. European Collaborators on Stent/graft techniques for aortic aneurysm repair. J Vasc Surg. 2000; 32(4):739-49
13. Benharash P, Lee JT, Abilez OJ, et al. Iliac fixation inhibits migration of both suprarenal and infrarenal aortic endografts. J Vasc Surg. 2007; 45(2):250-7.
14. QUL,G. HETZEL,D. RAITHEL. Seven year's single center experience of Powerlink unibody bifurcated endograft for endovasular aortic aneurysm repair.J Cardiovasc Surg 2007; 48:13-9
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16. Cao P, Verzini F, Zannetti S, et al. Device migration after endoluminal abdominal aortic aneurysm repair: analysis of 113 cases with a minimum follow-up period of 2 years. J Vasc Surg. 2002; 35(2):229-35
17. Mohan IV, Harris PL, Van Marrewijk CJ, et al. Factors and forces influencing stent-graft migration after endovascular aortic aneurysm repair. J Endovasc Ther. 2002; 9(6):748-55.
18. Li Z, Kleinstreuer C. Analysis of biomechanical factors affecting stent-graft migration in an abdominal aortic aneurysm model. J Biomech. 2006; 39(12):2264-73.
19. Sternbergh WC 3rd, Money SR, Greenberg RK, et al. Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith Multicenter Trial. J Vasc Surg. 2004; 39(1):20-6.
20. Zhou SS, How TV, Rao Vallabhaneni S, et al. Comparison of the fixation strength of standard and fenestrated stent-grafts for endovascular abdominal aortic aneurysm repair. J Endovasc Ther. 2007; 14(2): 168-75.
21. Malina M, Lindblad B, Ivancev K, et al. Endovascular AAA exclusion: will stents with hooks and barbs prevent stent-graft migration? J Endovasc Surg. 1998; 5(4):310-7.
22. Ruppert V, Leurs LJ, Hobo R, et al. Tube stent-grafts for infrarenal aortic aneurysm: a matched-paired analysis based on EUROSTAR data. Cardiovasc Intervent Radiol. 2007; 30(4):611-8. Epub 2007 Jun
23. Ruppert V, Erz K, Burklein D, et al. Double tube stent-grafts for infrarenal aortic aneurysm: a new concept. J Endovasc Ther. 2007 Apr; 14(2): 144-9
24. Biebl M, Hakaim AG, Lau LL, et al. Use of proximal aortic cuffs as an adjunctive procedure during endovascular aortic aneurysm repair. Vascular. 2005; 13(1):16-22.
25. Bashar AH, Kazui T, Washiyama N, et al. Mechanical properties of various z-stent designs: an endovascular stent-grafting perspective. Artif Organs. 2003 Aug;27(8):714-21
26. Grenacher L, Deutsch J, Lubienski A, et al. Resistance to hoop stress in balloon expandable stents: evaluation in an ex vivo model. Invest Radiol. 2003; 38(2):65-72.
27. May J, White GH, Ly CN, et al. Endoluminal repair of abdominal aortic aneurysm prevents enlargement of the proximal neck: a 9-year life-table and 5-year longitudinal study. J Vasc Surg. 2003; 37(1):86-90.
28. White RA, Donayre CE, Walot I, et al. Computed tomography assessment of abdominal aortic aneurysm morphology after endograft exclusion. J Vasc Surg. 2001; 33(2 Suppl):S1-10.
29. Sampaio SM, Panneton JM, Mozes G, et al. Aortic neck dilation after endovascular abdominal aortic aneurysm repair: should oversizing be blamed? Ann Vasc Surg. 2006; 20(3):338-45. Epub 2006 May 19.
30. Resch T, Ivancev K, Brunkwall J, et al. Midterm changes in aortic aneurysm morphology after endovascular repair. J Endovasc Ther. 2000; 7(4):279-85
31. Singh-Ranger R, Adiseshiah M.Differing morphological changes following endovascular AAA repair using balloon-expandable or self-expanding endografts. J Endovasc Ther. 2000; 7(6):479-85.
32. Cao P, Verzini F, Parlani G, et al. Predictive factors and clinical consequences of proximal aortic neck dilatation in 230 patients undergoing abdominal aorta aneurysm repair with self-expandable stent-grafts. J Vasc Surg. 2003; 37(6): 1200-5.
33. Sier MF, van Sambeek MR, Hendriks JM,et al. Shrinkage of abdominal aortic aneurysm after successful endovascular repair: results from single center study. J Cardiovasc Surg (Torino). 2006; 47(5):557-61.
34. Zarins CK, Bloch DA, Crabtree T,et al. Aneurysm enlargement following endovascular aneurysm repair: AneuRx clinical trial. J Vasc Surg. 2004; 39(1):109-17.
35. Torsello G, Osada N, Florek HJ, et al. Long-term outcome after Talent endograft implantation for aneurysms of the abdominal aorta: a multicenter retrospective study. J Vasc Surg. 2006; 43(2):277-84; discussion 284.
36. Melissano G, Bertoglio L, Esposito G, et al. Midterm clinical success and behavior of the aneurysm sac after endovascular AAA repair with the Excluder graft. J Vasc Surg. 2005; 42(6): 1052-7.
37. Cox DE, Jacobs DL, Motaganahalli RL, et al. Outcomes of endovascular AAA repair in patients with hostile neck anatomy using adjunctive balloon-expandable stents. Vasc Endovascular Surg. 2006 Jan-Feb;40(1):35-40
38. Goodney PP, Fillinger MF.The effect of endograft relining on sac expansion after endovascular aneurysm repair with the original-permeability Gore Excluder abdominal aortic aneurysm endoprosthesis. J Vasc Surg. 2007; 45(4):686-93.
39. Broker HS, Foteh KI, Murphy EH, et al. Device-specific aneurysm sac morphology after endovascular aneurysm repair: Evaluation of contemporary graft materials. J Vasc Surg. 2008 Feb, 22 .
40. Haider SE, Najjar SF, Cho JS, et al. Sac behavior after aneurysm treatment with the Gore Excluder low-permeability aortic endoprosthesis: 12-month comparison to the original Excluder device. J Vasc Surg. 2006; 44(4):694-700.
41. Smith ST, Clagett GP, Arko FR. Endovascular conversion with femorofemoral bypass as a treatment of endotension and aneurysm sac enlargement. J Vasc Surg. 2007 ;45(2):395-8
42. Trocciola SM, Dayal R, Chaer RA, et al. The development of endotension is associated with increased transmission of pressure and serous components in porous expanded polytetrafluoroethylene stent-grafts: characterization using a canine model. J Vasc Surg. 2006; 43(1): 109-16
43. Brevetti LS, Nackman GB, Graham AM.Perirenal fixation as an independent factor in aortic remodeling after endovascular aortic aneurysm repair. Ann Vasc Surg. 2004; 18(2): 138-42.
44. Jones JE, Atkins MD, Brewster DC, et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg. 2007; 46(1): 1-8.
45. Zarins CK, White RA, Hodgson KJ, et al. Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial. J Vasc Surg. 2000; 32(1):90-107.
46. Back MR, Bowser AN, Johnson BL, et al. Patency of infrarenal aortic side branches determines early aneurysm sac behavior after endovascular repair. Ann Vasc Surg. 2003; 17(1):27-34.
47. Fitta C, Miotto D, Barbiero G, et al. Morphological and functional modifications of the aneurysm-endograft complex following endoluminal treatment of abdominal aortic aneurysms. Radiol Med (Torino). 2006; 111(7):931-48.
48. Back MR, Bowser AN, Johnson BL, et al. Patency of infrarenal aortic side branches determines early aneurysm sac behavior after endovascular repair. Ann Vasc Surg. 2003; 17(1):27-34.
49. Golledge J, Muller J, Daugherty A, Norman P.Abdominal aortic aneurysm: pathogenesis and implications for management. Arterioscler Thromb Vasc Biol. 2006; 26(12):2605-13.
2. Bohm T, Soldner J, Rott A, Kaiser WA. Perigraft leak of an aortic stent graft due to material fatigue. AJR Am J Roentgenol 1999; 172:1355-1357.
3. Moise MA, Woo EY, Velazquez OC, et al. Barriers to endovascular aortic aneurysm repair: past experience and implications for future device development. Vasc Endovascular Surg. 2006; 40(3): 197-203.
4. Noriyuki Kato, Takatsugu Shimono, Tadanori Hirano, et al. Aneurysm Expansion after Stent-Graft Placement in the Absence of Endoleak. J Vasc Interv Radiol. 2002; 13:321-326.
5. Roy K. Greenberg, David Deaton, Timothy Sullivan, et al. Variable sac behavior after endovascular repair of abdominal aortic aneurysm: Analysis of core laboratory data. J Vasc Surg. 2004; 39:95-101.
6. Litwinski RA, Donayre CE, et al. The role of aortic neck dilation and elongation in the etiology of stent graft migration after endovascular abdominal aortic aneurysm repair with a passive fixation device. J Vasc Surg. 2006; 44(6): 1176-81.
7. Torsello G, Osada N, Florek HJ, et al. Long-term outcome after Talent endograft implantation for aneurysms of the abdominal aorta: a multicenter retrospective study. J Vasc Surg. 2006; 43(2): 277-84.
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9．范隆华,陈福真,叶建荣等．腹主动脉瘤自然病程研究．中华外科杂志．1999；8(37)：510．
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11. Goodney PP, Fillinger MF.The effect of endograft relining on sac expansion after endovascular aneurysm repair with the original-permeability Gore Excluder abdominal aortic aneurysm endoprosthesis. J Vasc Surg. 2007; 45(4):686-93.
12. Sier MF, van Sambeek MR, Hendriks JM,et al. Shrinkage of abdominal aortic aneurysm after successful endovascular repair: results from single center study. J Cardiovasc Surg (Torino). 2006; 47(5):557-61.
13. Zarins CK, Bloch DA, Crabtree T,et al. Aneurysm enlargement following endovascular aneurysm repair: AneuRx clinical trial. J Vasc Surg. 2004; 39(1):109-17.
14. Torsello G, Osada N, Florek HJ, et al. Long-term outcome after Talent endograft implantation for aneurysms of the abdominal aorta: a multicenter retrospective study. J Vasc Surg. 2006; 43(2):277-84.
15. Melissano G, Bertoglio L, Esposito G, et al. Midterm clinical success and behavior of the aneurysm sac after endovascular AAA repair with the Excluder graft. J Vasc Surg. 2005; 42(6): 1052-7.
16. Cox DE, Jacobs DL, Motaganahalli RL, et al. Outcomes of endovascular AAA repair in patients with hostile neck anatomy using adjunctive balloon-expandable stents. Vasc Endovascular Surg. 2006; 40(1):35-40
17. Singh-Ranger R, Adiseshiah M.Differing morphological changes following endovascular AAA repair using balloon-expandable or self-expanding endografts. J Endovasc Ther. 2000; 7(6):479-85.
18. Fitta C, Miotto D, Barbiero G, et al. Morphological and functional modifications of the aneurysm-endograft complex following endoluminal treatment of abdominal aortic aneurysms. Radiol Med (Torino). 2006; 111(7): 931-48.
19. Greenberg RK, Deaton D, Sullivan T, et al. Variable sac behavior after endovascular repair of abdominal aortic aneurysm: analysis of core laboratory data. J Vasc Surg. 2004; 39(1)95-101.
20. Trocciola SM, Dayal R, Chaer RA, et al. The development of endotension is associated with increased transmission of pressure and serous components in porous expanded polytetrafluoroethylene stent-grafts: characterization using a canine model. J Vasc Surg. 2006; 43(1): 109-16.
21. Jones JE, Atkins MD, Brewster DC, et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg. 2007; 46(1): 1-8.
22. 16Zarins CK, White RA, Hodgson KJ, et al. Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial. J Vasc Surg. 2000; 32(1): 90-107.
23. Chaikof EL, Blankensteijn JD, Harris PL, et al. Ad Hoc Committee for Standardized Reporting Practices in Vascular Surgery of the Society for Vascular Surgery/American Association for Vascular Surgery: reporting standards for endovascular aortic aneurysm repair. J Vasc Surg. 2002; 35:1048 -1060.
24. Sier MF, van Sambeek MR, Hendriks JM,et al. Shrinkage of abdominal aortic aneurysm after successful endovascular repair: results from single center study. J Cardiovasc Surg (Torino). 2006; 47(5):557-61.
25. Zarins CK, Crabtree T, Bloch DA, et al. Endovascular aneurysm repair at 5 years: Does aneurysm diameter predict outcome? J Vasc Surg. 2006; 44(5):920-29.
1. Malas MB, Ohki T, Veith FJ, et al. Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts. J Vasc Surg. 2005; 42(4):639-44.
2. White RA, Donayre CE, Walot I, et al. Computed tomography assessment of abdominal aortic aneurysm morphology after endograft exclusion. J Vasc Surg. 2001; 33(2 Suppl):Sl-10.
3. Sternbergh WC 3rd, Money SR, Greenberg RK, et al. Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith Multicenter Trial. J Vasc Surg. 2004; 39(1):20-6
4. Malas MB, Ohki T, Veith FJ, et al. Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts. J Vasc Surg. 2005; 42(4):639-44
5. Cao P, Verzini F, Parlani G, et al. Predictive factors and clinical consequences of proximal aortic neck dilatation in 230 patients undergoing abdominal aorta aneurysm repair with self-expandable stent-grafts. J Vasc Surg. 2003;
37(6): 1200-5.
6. Hirofumi Midorikawa, Tomohiro Ogawa, Kouichi Satou, et al. Morphological Study of Abdominal Aortic Aneurysm: Optimal Stent-graft Size for Japanese Patients.Ann Thorac Cardiovasc Surg Vol. 2006 12(2).
7. Sampaio SM, Panneton JM, Mozes G, et al. AneuRx device migration: incidence, risk factors, and consequences. Ann Vasc Surg. 2005; 19(2): 178-85.
8. Sampaio SM, Panneton JM, Mozes G, et al. Aortic neck dilation after endovascular abdominal aortic aneurysm repair: should oversizing be blamed? Ann Vasc Surg. 2006; 20(3):338-45.
1. Becquemin JR Kelley L, Zubilewicz T, et al. Outcomes of secondary interventions after abdominal aortic aneurysm endovascular repair. J Vasc Surg 2004; 39:298-305.
2. Andrew England, BSc (Hons), MSc, John S. Butterfield, et al. Device Migration after Endovascular Abdominal Aortic Aneurysm Repair: Experience with a Talent Stent-Graft. J Vasc Interv Radiol. 2004; 15:1399-1405
3. Li Z, Kleinstreuer C. Analysis of biomechanical factors affecting stent-graft migration in an abdominal aortic aneurysm model. J Biomech. 2006; 39(12):2264-73.
4. Benharash P, Lee JT, Abilez OJ ,et, al. Iliac fixation inhibits migration of both suprarenal and infrarenal aortic endografts. J Vasc Surg. 2007; 45(2):250-7.
5. Heikkinen MA, Alsac JM, Arko FR, et al. The importance of iliac fixation in prevention of stent graft migration. J Vasc Surg. 2006; 43(6): 1130-7.
6. Tonnessen BH, Sternbergh WC 3rd, Money SR. Mid- and long-term device migration after endovascular abdominal aortic aneurysm repair, a comparison of AneuRx and Zenith endografts. J Vasc Surg. 2005; 42(3):392-400.
7. Lee JT, Lee J, Aziz I.Stent-graft migration following endovascular repair of aneurysms with large proximal necks: anatomical risk factors and long-term sequelae. J Endovasc Ther. 2002; 9(5):652-64.
8. Resch T, Ivancev K, Brunkwall J, et al. Distal migration of stent-grafts after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 1999; 10(3):257-64.
9. Zarins CK, Bloch DA, Crabtree T, et al. Stent graft migration after endovascular aneurysm repair: importance of proximal fixation. J Vasc Surg. 2003; 38(6): 1264-72.
10. Malas MB, Ohki T, Veith FJ, et al. Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts. J Vasc Surg. 2005; 42(4):639-44.
11.Sampaio SM, Panneton JM, Mozes G, et al. AneuRx device migration: incidence, risk factors, and consequences. Ann Vasc Surg. 2005; 19(2): 178-85.
12. Benharash P, Lee JT, Abilez OJ, et al. Iliac fixation inhibits migration of both suprarenal and infrarenal aortic endografts. J Vasc Surg. 2007; 45(2):250-7.
13. Ruppert V, Leurs LJ, Hobo R, et al. Tube stent-grafts for infrarenal aortic aneurysm: a matched-paired analysis based on EUROSTAR data.Cardiovasc Intervent Radiol. 2007; 30(4)611-8.
14. Sternbergh WC 3rd, Money SR, Greenberg RK, et al. Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith Multicenter Trial. J Vasc Surg. 2004; 39(1):20-6.
15. Malina M, Ivancev K, Chuter TAM, et al. Changing aneurysm morphology after endovascular grafting: relation to leakage or persistent perfusion. J Endovasc Surg. 1997; 4:23-30.
16. Cao P, Verzini F, Zannetti S, et al. Device migration after endoluminal abdominal aortic aneurysm repair: analysis of 113 cases with a minimum follow-up period of 2 years. J Vasc Surg. 2002; 35(2):229-35
17. Mohan IV, Harris PL, Van Marrewijk CJ, et al. Factors and forces influencing stent-graft migration after endovascular aortic aneurysm repair. J Endovasc Ther. 2002; 9(6):748-55.
1. Litwinski RA, Donayre CE, et al. The role of aortic neck dilation and elongation in the etiology of stent graft migration after endovascular abdominal aortic aneurysm repair with a passive fixation device. J Vasc Surg. 2006; 44(6): 1176-81.
2. Ouriel K, Clair DG, Greenberg RK, et al. Endovascular repair of abdominal aortic aneurysms: Device-specific outcome. J Vasc Surg. 2003; 37:991-998
3. Resch T, Ivancev K, Brunkwall J, et al. Distal migration of stent-grafts after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 1999; 10(3):257-64; discussion 265-6.
4. Tonnessen BH, Sternbergh WC 3rd, Money SR. Mid- and long-term device migration after endovascular abdominal aortic aneurysm repair: a comparison of AneuRx and Zenith endografts. J Vasc Surg. 2005; 42(3):392-400.
5. Zarins CK, Bloch DA, Crabtree T, et al. Stent graft migration after endovascular aneurysm repair: importance of proximal fixation. J Vasc Surg. 2003; 38(6): 1264-72; discussion 1272.
6. Malas MB, Ohki T, Veith FJ, et al. Absence of proximal neck dilatation and graft migration after endovascular aneurysm repair with balloon-expandable stent-based endografts. J Vasc Surg. 2005; 42(4):639-44.
7. Dalainas I, Nano G, Bianchi P, et al. Aortic neck dilatation and endograft migration are correlated with self-expanding endografts. J Endovasc Ther. 2007; 14(3)318-23.
8. Greenberg RK, Deaton D, Sullivan T, et al. Variable sac behavior after endovascular repair of abdominal aortic aneurysm: analysis of core laboratory data. J Vasc Surg. 2004; 39(1):95-101.
9. Heikkinen MA, Alsac JM, Arko FR, et al. The importance of iliac fixation in prevention of stent graft migration. J Vasc Surg. 2006 Jun;43(6):l 130-7.
10. Sampaio SM, Panneton JM, Mozes G, et al. AneuRx device migration: incidence, risk factors, and consequences. Ann Vasc Surg. 2005; 19(2): 178-85.
11. Lee JT, Lee J, Aziz I, et al. Stent-graft migration following endovascular repair of aneurysms with large proximal necks: anatomical risk factors and iong-term sequelae. J Endovasc Ther. 2002; 9(5):652-64.
12. Harris PL, Vallabhaneni SR, Desgranges P, et al. Incidence and risk factors of late rupture, conversion, and death after endovascular repair of infrarenal aortic aneurysms: the EUROSTAR experience. European Collaborators on Stent/graft techniques for aortic aneurysm repair. J Vasc Surg. 2000; 32(4):739-49
13. Benharash P, Lee JT, Abilez OJ, et al. Iliac fixation inhibits migration of both suprarenal and infrarenal aortic endografts. J Vasc Surg. 2007; 45(2):250-7.
14. QUL,G. HETZEL,D. RAITHEL. Seven year's single center experience of Powerlink unibody bifurcated endograft for endovasular aortic aneurysm repair.J Cardiovasc Surg 2007; 48:13-9
15. Hobo R, Kievit J, Leurs LJ, et al. Influence of severe infrarenal aortic neck angulation on complications at the proximal neck following endovascular AAA repair: a EUROSTAR study. J Endovasc Ther. 2007; 14(1): 1-11
16. Cao P, Verzini F, Zannetti S, et al. Device migration after endoluminal abdominal aortic aneurysm repair: analysis of 113 cases with a minimum follow-up period of 2 years. J Vasc Surg. 2002; 35(2):229-35
17. Mohan IV, Harris PL, Van Marrewijk CJ, et al. Factors and forces influencing stent-graft migration after endovascular aortic aneurysm repair. J Endovasc Ther. 2002; 9(6):748-55.
18. Li Z, Kleinstreuer C. Analysis of biomechanical factors affecting stent-graft migration in an abdominal aortic aneurysm model. J Biomech. 2006; 39(12):2264-73.
19. Sternbergh WC 3rd, Money SR, Greenberg RK, et al. Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith Multicenter Trial. J Vasc Surg. 2004; 39(1):20-6.
20. Zhou SS, How TV, Rao Vallabhaneni S, et al. Comparison of the fixation strength of standard and fenestrated stent-grafts for endovascular abdominal aortic aneurysm repair. J Endovasc Ther. 2007; 14(2): 168-75.
21. Malina M, Lindblad B, Ivancev K, et al. Endovascular AAA exclusion: will stents with hooks and barbs prevent stent-graft migration? J Endovasc Surg. 1998; 5(4):310-7.
22. Ruppert V, Leurs LJ, Hobo R, et al. Tube stent-grafts for infrarenal aortic aneurysm: a matched-paired analysis based on EUROSTAR data. Cardiovasc Intervent Radiol. 2007; 30(4):611-8. Epub 2007 Jun
23. Ruppert V, Erz K, Burklein D, et al. Double tube stent-grafts for infrarenal aortic aneurysm: a new concept. J Endovasc Ther. 2007 Apr; 14(2): 144-9
24. Biebl M, Hakaim AG, Lau LL, et al. Use of proximal aortic cuffs as an adjunctive procedure during endovascular aortic aneurysm repair. Vascular. 2005; 13(1):16-22.
25. Bashar AH, Kazui T, Washiyama N, et al. Mechanical properties of various z-stent designs: an endovascular stent-grafting perspective. Artif Organs. 2003 Aug;27(8):714-21
26. Grenacher L, Deutsch J, Lubienski A, et al. Resistance to hoop stress in balloon expandable stents: evaluation in an ex vivo model. Invest Radiol. 2003; 38(2):65-72.
27. May J, White GH, Ly CN, et al. Endoluminal repair of abdominal aortic aneurysm prevents enlargement of the proximal neck: a 9-year life-table and 5-year longitudinal study. J Vasc Surg. 2003; 37(1):86-90.
28. White RA, Donayre CE, Walot I, et al. Computed tomography assessment of abdominal aortic aneurysm morphology after endograft exclusion. J Vasc Surg. 2001; 33(2 Suppl):S1-10.
29. Sampaio SM, Panneton JM, Mozes G, et al. Aortic neck dilation after endovascular abdominal aortic aneurysm repair: should oversizing be blamed? Ann Vasc Surg. 2006; 20(3):338-45. Epub 2006 May 19.
30. Resch T, Ivancev K, Brunkwall J, et al. Midterm changes in aortic aneurysm morphology after endovascular repair. J Endovasc Ther. 2000; 7(4):279-85
31. Singh-Ranger R, Adiseshiah M.Differing morphological changes following endovascular AAA repair using balloon-expandable or self-expanding endografts. J Endovasc Ther. 2000; 7(6):479-85.
32. Cao P, Verzini F, Parlani G, et al. Predictive factors and clinical consequences of proximal aortic neck dilatation in 230 patients undergoing abdominal aorta aneurysm repair with self-expandable stent-grafts. J Vasc Surg. 2003; 37(6): 1200-5.
33. Sier MF, van Sambeek MR, Hendriks JM,et al. Shrinkage of abdominal aortic aneurysm after successful endovascular repair: results from single center study. J Cardiovasc Surg (Torino). 2006; 47(5):557-61.
34. Zarins CK, Bloch DA, Crabtree T,et al. Aneurysm enlargement following endovascular aneurysm repair: AneuRx clinical trial. J Vasc Surg. 2004; 39(1):109-17.
35. Torsello G, Osada N, Florek HJ, et al. Long-term outcome after Talent endograft implantation for aneurysms of the abdominal aorta: a multicenter retrospective study. J Vasc Surg. 2006; 43(2):277-84; discussion 284.
36. Melissano G, Bertoglio L, Esposito G, et al. Midterm clinical success and behavior of the aneurysm sac after endovascular AAA repair with the Excluder graft. J Vasc Surg. 2005; 42(6): 1052-7.
37. Cox DE, Jacobs DL, Motaganahalli RL, et al. Outcomes of endovascular AAA repair in patients with hostile neck anatomy using adjunctive balloon-expandable stents. Vasc Endovascular Surg. 2006 Jan-Feb;40(1):35-40
38. Goodney PP, Fillinger MF.The effect of endograft relining on sac expansion after endovascular aneurysm repair with the original-permeability Gore Excluder abdominal aortic aneurysm endoprosthesis. J Vasc Surg. 2007; 45(4):686-93.
39. Broker HS, Foteh KI, Murphy EH, et al. Device-specific aneurysm sac morphology after endovascular aneurysm repair: Evaluation of contemporary graft materials. J Vasc Surg. 2008 Feb, 22 .
40. Haider SE, Najjar SF, Cho JS, et al. Sac behavior after aneurysm treatment with the Gore Excluder low-permeability aortic endoprosthesis: 12-month comparison to the original Excluder device. J Vasc Surg. 2006; 44(4):694-700.
41. Smith ST, Clagett GP, Arko FR. Endovascular conversion with femorofemoral bypass as a treatment of endotension and aneurysm sac enlargement. J Vasc Surg. 2007 ;45(2):395-8
42. Trocciola SM, Dayal R, Chaer RA, et al. The development of endotension is associated with increased transmission of pressure and serous components in porous expanded polytetrafluoroethylene stent-grafts: characterization using a canine model. J Vasc Surg. 2006; 43(1): 109-16
43. Brevetti LS, Nackman GB, Graham AM.Perirenal fixation as an independent factor in aortic remodeling after endovascular aortic aneurysm repair. Ann Vasc Surg. 2004; 18(2): 138-42.
44. Jones JE, Atkins MD, Brewster DC, et al. Persistent type 2 endoleak after endovascular repair of abdominal aortic aneurysm is associated with adverse late outcomes. J Vasc Surg. 2007; 46(1): 1-8.
45. Zarins CK, White RA, Hodgson KJ, et al. Endoleak as a predictor of outcome after endovascular aneurysm repair: AneuRx multicenter clinical trial. J Vasc Surg. 2000; 32(1):90-107.
46. Back MR, Bowser AN, Johnson BL, et al. Patency of infrarenal aortic side branches determines early aneurysm sac behavior after endovascular repair. Ann Vasc Surg. 2003; 17(1):27-34.
47. Fitta C, Miotto D, Barbiero G, et al. Morphological and functional modifications of the aneurysm-endograft complex following endoluminal treatment of abdominal aortic aneurysms. Radiol Med (Torino). 2006; 111(7):931-48.
48. Back MR, Bowser AN, Johnson BL, et al. Patency of infrarenal aortic side branches determines early aneurysm sac behavior after endovascular repair. Ann Vasc Surg. 2003; 17(1):27-34.
49. Golledge J, Muller J, Daugherty A, Norman P.Abdominal aortic aneurysm: pathogenesis and implications for management. Arterioscler Thromb Vasc Biol. 2006; 26(12):2605-13.