Baldwin Z K, Chuter T A M, Hiramoto J S, Reilly L M, Schneider D B
Division of Vascular Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
Ann Vasc Surg. 2008 Nov;22(6):703-9. doi: 10.1016/j.avsg.2008.06.002. Epub 2008 Aug 5.
Thoracic endovascular aortic repair (TEVAR) may involve either planned or inadvertent coverage of aortic branch vessels when stent grafts are implanted into the aortic arch. Vital branch vessels may be preserved by surgical debranching techniques or by placement of additional stents to maintain vessel patency. We report our experience with a double-barrel stent technique used to maintain aortic arch branch vessel patency during TEVAR. Seven patients underwent TEVAR using the double-barrel technique, with placement of branch stents into the innominate (n = 3), left common carotid (n = 3), and left subclavian (n = 1) arteries alongside an aortic stent graft. Gore TAG endografts were used in all cases, and either self-expanding stents (n = 6) or balloon-expandable (n = 1) stents were utilized to maintain patency of the arch branch vessels. In three cases the double-barrel stent technique was used to restore patency of an inadvertently covered left common carotid artery. Four planned cases involved endograft deployment proximally into the ascending aorta with placement of an innominate artery stent (n = 3) and coverage of the left subclavian artery with placement of a subclavian artery stent (n = 1). TEVAR using a double-barrel stent was technically successful with maintenance of branch vessel patency and absence of type I endoleak in all seven cases. One case of zone 0 endograft placement with an innominate stent was complicated by a left hemispheric stroke that was attributed to a technical problem with the carotid-carotid bypass. On follow-up of 2-18 months, all double-barrel branch stents and aortic endografts remained patent without endoleak, migration, or loss of device integrity. The double-barrel stent technique maintains aortic branch patency and provides additional stent-graft fixation length during TEVAR to treat aneurysms involving the aortic arch. Moreover, the technique uses commercially available devices and permits complete aortic arch coverage (zone 0) without a sternotomy. Although initial outcomes are encouraging, long-term durability remains unknown.
当将覆膜支架植入主动脉弓时，胸主动脉腔内修复术（TEVAR）可能会涉及对主动脉分支血管的计划性或意外性覆盖。重要分支血管可通过外科去分支技术或放置额外支架以维持血管通畅来予以保留。我们报告了我们使用双筒支架技术在TEVAR期间维持主动脉弓分支血管通畅的经验。7例患者采用双筒技术进行TEVAR，在植入主动脉覆膜支架的同时，将分支支架分别植入无名动脉（n = 3）、左颈总动脉（n = 3）和左锁骨下动脉（n = 1）。所有病例均使用戈尔TAG覆膜支架，采用自膨式支架（n = 6）或球囊扩张式支架（n = 1）来维持弓部分支血管的通畅。在3例病例中，双筒支架技术用于恢复意外被覆盖的左颈总动脉的通畅。4例计划性病例包括将覆膜支架近端植入升主动脉，同时植入无名动脉支架（n = 3），并通过植入锁骨下动脉支架覆盖左锁骨下动脉（n = 1）。使用双筒支架的TEVAR在技术上取得成功，所有7例病例均维持了分支血管通畅且无I型内漏。1例在无名动脉支架植入时进行0区覆膜支架置入的病例出现了左侧半球性卒中，这归因于颈动脉-颈动脉旁路的技术问题。在2至18个月的随访中，所有双筒分支支架和主动脉覆膜支架均保持通畅，无内漏、移位或器械完整性丧失。双筒支架技术可维持主动脉分支通畅，并在TEVAR治疗累及主动脉弓的动脉瘤时提供额外的覆膜支架固定长度。此外，该技术使用市售器械，无需开胸即可实现对整个主动脉弓的覆盖（0区）。尽管初始结果令人鼓舞，但其长期耐久性仍未知。
