Brooks M, Loftus I, Morgan R, Thompson M
St George's Vascular Institute, London, UK.
J Cardiovasc Surg (Torino). 2006 Jun;47(3):269-78.
Thoracic aortic pathology is common, but conventional surgery carries with it a significant risk of mortality and morbidity due to thoracotomy, extensive surgical dissection, partial left lung collapse, proximal aortic cross-clamping and blood loss necessary for open thoracic aortic replacement. Endovascular techniques have the potential to remove much of this harm. However, endograft delivery to the thoracic aorta brings its own challenges; the graft and delivery system must be conformable to follow the aortic arch, flexible to track through tortuous calcified vessels, of low profile for access through the iliac arteries, and deploy accurately and with minimal force to avoid accidental side branch occlusion. The endoprosthesis must also prove to be durable. This paper reviews current indications for thoracic aortic stent grafts and the properties of an ideal endograft for deployment in the arch and descending aorta. The Medtronic Valiant TM endoprosthesis with Xcelerant TM Delivery System is a third-generation system designed specifically for the treatment of a range of thoracic aortic pathologies, including but not exclusively, aneurysms and dissections. The design of the Valiant endoprosthesis and delivery system are described in detail, and compared to the second-generation Talent system. Our early experience of using Valiant in 28 patients with a range of pathologies is described. The graft achieved an initial technical success in 93% and was easy to position and deploy. Long-term data is now required; the Virtue Registry is a prospective multicenter European registry collecting clinical and health economics data on Valiant in the management of aortic dissections.
胸主动脉病变很常见，但传统手术因开胸、广泛的手术解剖、部分左肺萎陷、近端主动脉阻断和开放性胸主动脉置换所需的失血而带来显著的死亡和发病风险。血管内技术有可能消除大部分此类危害。然而，将血管内移植物输送到胸主动脉也带来了自身的挑战；移植物和输送系统必须符合主动脉弓的形态，能够灵活地通过迂曲钙化的血管，外形小巧以便通过髂动脉进入，并且能够精确部署且用力最小以避免意外阻塞侧支血管。血管内假体还必须证明具有耐久性。本文综述了胸主动脉支架移植物的当前适应证以及用于在主动脉弓和降主动脉中部署的理想血管内移植物的特性。带有Xcelerant TM输送系统的美敦力Valiant TM血管内假体是第三代系统，专门设计用于治疗一系列胸主动脉病变，包括但不限于动脉瘤和夹层。详细描述了Valiant血管内假体和输送系统的设计，并与第二代Talent系统进行了比较。描述了我们在28例患有一系列病变的患者中使用Valiant的早期经验。该移植物的初始技术成功率为93%，易于定位和部署。现在需要长期数据；Virtue注册研究是一项前瞻性多中心欧洲注册研究，收集关于Valiant在主动脉夹层治疗中的临床和卫生经济学数据。
