İlhan SANİSOĞLU, Liva Ertan SAĞBAŞ, Barış ÇAYNAK, Zehra BAYRAMOĞLU, Ayhan MUTLU, Levent ONAT

Endurant stent greft erken dönem sonuçları ve Talent stent greft ile karşılaştırılması

Amaç: Bu çalışmada Endurant (Medtronic) stent greft kullanılarak yapılan abdominal aort anevrizması tedavisinde erken dönem sonuçları değerlendirildi ve Talent (Medtronic) endogreft sonuçları ile karşılaştırıldı. Çalışma planı: Ocak 2009 - Şubat 2010 tarihleri arasında Endurant stent greft ile tedavi edilen 12 hastada (1 kadın, 11 erkek; ort. yaş 74 yıl; dağılım 59-86 yıl) teknik başarı, greftten kontrast kaçışı ve ameliyat sırası mortalite oranları belgelendi. Bu hastaların 10'u infrarenal anevrizma, biri penetran aortik ülser, biri rüptüre iliyak anevrizma endikasyonu ile tedavi edildi. Elde edilen bulgular Kasım 2004 - Ocak 2009 tarihleri arasında abdominal aort anevrizması Talent endogreft ile tedavi edilen 23 hasta (2 kadın, 21 erkek; ort. yaş 72 yıl; dağılım 61-82 yıl) ile karşılaştırıldı.Bulgular: Endurant stent greft uygulanan 12 hastada teknik başarı sağlandı. On iki hastanın dokuzunda aortobiiliyak ve üçünde tüp greft kullanıldı. Ameliyat sonrası erken dönem kontrol bilgisayarlı tomografi anjiyografisinde kontrast kaçışı saptanmadı. Anevrizma çapları 51-72 mm, anevrizma boynu 10-20 mm, anevrizma boynu açılanması 0-90 derece arasında ölçüldü. Otuz günü aşkın bir sürede ne anevrizmaya bağlı ne de açık tamir dönüşümüne bağlı ölüm olmadı. Talent grubunda anevrizma çapları 50-80 mm, anevrizma boynu 8-25 mm, boyun açısı 0-60 derece aralığındaydı. Talent grubunda dört aortouniiliyak, 19 aortobiiliyak greft kullanıldı. Bu 23 hastada iki- adet tip 1 kaçış proksimal ek greft ile tedavi edildi ve iki adet tip 2 kaçış takipte düzeldi.Sonuç: Yeni geliştirilen endurant stent greft düşük profili ile daralmış iliyak damarlarda ve açılı boyunlarda daha kolay yerleştirilmekte ve açılmaktadır. Ancak greft migrasyonu ve stenotik damarlarda açık kalımı yönünden uzun süreli takiplerle değerlendirilmelidir.

Preliminary results of endurant stent grafts and comparison with talent stent grafts

Background: In the present study, we compared early results of Endurant (Medtronic) stent grafts used in the treatment of abdominal aortic aneurysms with Talent (Medtronic) endografts. Methods: In 12 patients (1 female, 11 males; mean age 74 years; range 59 to 86 years) treated with the Endurant stent grafts between January 2009 and February 2010, the outcomes of technical success, endoleak and perioperative mortality rates were documented. These patients were treated with indications of infrarenal aneurysms (n=10), penetrating atherosclerotic ulcer (n=1) or ruptured iliac aneurysm (n=1). These results were compared with 23 patiens (2 females, 21 males; mean age 72; years; range 61 to 82 years) whose abdominal aortic aneurysms were treated with the Talent endografts between November 1994 and January 2009.Results: Technical success was achieved in the 12 patients with the Endurant stent grafts. In nine of these 12 patients aortobiiliac tube grafts and in the remaning three patients tube grafts were used. No endoleak was detected at the early postoperative control computed tomography angiography. Aneurysm diameters were 51-72 mm, aneurysm necks were 10-20 mm and aneurysms neck angulations were measured as 0-90 degrees. Neither aneurysmal nor conversion to open repair-related deaths have been observed over 30 days. In the Talent group, the aneurysm diameters were 50-80 mm, aneurysm necks were 8-25 mm and aneursym angulations were measured as 0-60 degrees. In the Talent group four aortouniiliac and 19 aortobiiliac grafts were used. In these 23 patients two type 1 leaks were treated with a proximal cuff and two type 2 leaks disappeared during the follow-up.Conclusion: The newly developed Endurant stent graft with a low profile can be delivered and deployed in angulated necks and stenotic iliac vessels. However, it should be assessed with long-term follow-ups in terms of graft migration and patency.

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