Inoue K, Hosokawa H, Iwase T, Sato M, Yoshida Y, Ueno K, Tsubokawa A, Tanaka T, Tamaki S, Suzuki T
Department of Cardiovascular Surgery, Takeda Hospital, Kyoto, Japan.
Circulation. 1999 Nov 9;100(19 Suppl):II316-21. doi: 10.1161/01.cir.100.suppl_2.ii-316.
Recently, thoracic aortic stent grafting has emerged as an alternative therapeutic modality for patients with thoracic aortic aneurysms and aortic dissections. However, its application has been limited to descending thoracic aortic aneurysms distal to the aortic arch. We report our initial clinical experience of endovascular branched stent graft repair for aortic arch aneurysms.
Endovascular grafting with Inoue branched stent grafts was attempted for 15 patients with thoracic aortic aneurysms and aortic dissections under local anesthesia (n=14) or general anesthesia (n=1). Single-branched stent grafts were used in 14 patients, and a triple-branched stent graft in one. The branched stent grafts were delivered through a 22F or a 24F sheath under fluoroscopic guidance and implanted across the aneurysmal aortic arch. In 2 patients, the single-branched stent graft did not pass through the 22F sheath used. Complete thrombosis of the aneurysm was ultimately achieved in 11 patients (73%). Of 4 persistent leaks, 1 minor leak spontaneously thrombosed and 1 major leak was successfully treated by additional straight stent graft placement. In 1 patient, the right external iliac artery ruptured during the withdrawal of the sheath and was successfully repaired by the implantation of a straight stent graft. One patient with severe stenosis of the aortic graft section was successfully managed by additional stent deployment. Peripheral microembolization to a toe occurred in 1 patient, and cerebral infarction occurred in 1 other patient. Two patients who had failed to receive endovascular stent grafts died during an average follow-up of 12.6 months, 1 of pneumonia and the other of rupture of a concomitant abdominal aortic aneurysm.
This report demonstrates the technical feasibility of endovascular branched stent graft repair for aneurysms located at the aortic arch. Careful, longer follow-up and further extensive clinical trials are awaited toward establishing this technique as a recommendable alternative to surgical treatment of thoracic aortic aneurysms.
最近，胸主动脉支架植入术已成为胸主动脉瘤和主动脉夹层患者的一种替代治疗方式。然而，其应用仅限于主动脉弓远端的降主动脉瘤。我们报告了我们使用血管内分支支架植入术修复主动脉弓瘤的初步临床经验。
在局部麻醉（n = 14）或全身麻醉（n = 1）下，尝试对15例胸主动脉瘤和主动脉夹层患者使用井上分支支架进行血管内植入。14例患者使用单分支支架，1例使用三分支支架。分支支架在荧光透视引导下通过22F或24F鞘管输送，并跨越主动脉弓瘤进行植入。2例患者中，单分支支架无法通过所用的22F鞘管。最终11例患者（73%）的动脉瘤完全血栓形成。4例持续性渗漏中，1例轻微渗漏自发血栓形成，1例严重渗漏通过额外植入直型支架成功治疗。1例患者在撤出鞘管时右髂外动脉破裂，通过植入直型支架成功修复。1例主动脉移植物段严重狭窄的患者通过额外植入支架成功处理。1例患者出现脚趾周围微栓塞，另1例患者发生脑梗死。2例未能接受血管内支架植入的患者在平均12.6个月的随访期间死亡，1例死于肺炎，另1例死于同时存在的腹主动脉瘤破裂。
本报告证明了血管内分支支架植入术修复位于主动脉弓的动脉瘤的技术可行性。为了将该技术确立为胸主动脉瘤手术治疗的推荐替代方法，还需要进行仔细、长期的随访和进一步广泛的临床试验。
