Section of Vascular and Endovascular Surgery, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
J Vasc Surg. 2011 Jun;53(6):1485-91. doi: 10.1016/j.jvs.2011.01.053. Epub 2011 Apr 16.
Treatment of complex thoracic aortic pathology increasingly requires coverage of one or more aortic arch vessels. Endovascular debranching with a chimney technique can reduce or eliminate the need for surgical bypass. In this study, we evaluate our initial experience with planned endovascular debranching of the aortic arch.
During a 13-month period, nine patients were treated with endovascular debranching during thoracic endograft placement. Balloon expandable (n = 7) or self-expanding stents (n = 2) were deployed (innominate, n = 2; left common carotid, n = 2; left subclavian, n = 5) along with either TAG (W. L. Gore, Flagstaff, Ariz; n = 8) or Talent (Medtronic, Minneapolis, Minn; n = 1) endografts. Four patients required six surgical bypasses to additional arch vessels (right to left common carotid artery, n = 2; left common carotid to subclavian artery, n = 4).
Indications for thoracic endograft placement were aortic transection (n = 4), aortic aneurysm (n = 2), aortotracheal fistula (n = 1), contained aortic aneurysm rupture (n = 1), and acute aortic dissection (n = 1). Endografts were deployed into zones 0 (n = 2), 1 (n = 2), and 2 (n = 5). Technical success of endovascular debranching was attained in eight of nine patients, with maintenance of branch perfusion and absence of endoleak. Perioperative morbidity included one myocardial infarction and one stroke that resulted in the patient's death. During subsequent follow-up (range, 2-25 months), there were no instances of endoleak secondary to chimney stents. All debranched vessels maintained primary patency.
Endovascular debranching permits planned extension of the thoracic endograft over arch vessels while further minimizing the need for open reconstruction. Short-term results indicate technical feasibility of this approach. Long-term outcomes remain undefined.
治疗复杂的胸主动脉病变越来越需要覆盖一个或多个主动脉弓血管。腔内去分支技术（chimney technique）可以减少或消除对手术旁路的需求。在这项研究中，我们评估了我们在计划的主动脉弓腔内去分支的初始经验。
在 13 个月的时间里，9 名患者在胸主动脉内修复期间接受了腔内去分支治疗。球囊扩张型（n = 7）或自膨式支架（n = 2）在（无名动脉，n = 2；左颈总动脉，n = 2；左锁骨下动脉，n = 5）与 TAG（戈尔，Flagstaff，Ariz；n = 8）或 Talent（美敦力，明尼苏达州，明尼阿波利斯；n = 1）内支架同时部署。4 名患者需要对额外的弓状血管（右至左颈总动脉，n = 2；左颈总动脉至锁骨下动脉，n = 4）进行 6 次外科旁路。
胸主动脉内修复的指征为主动脉夹层（n = 4）、主动脉瘤（n = 2）、主动脉-气管瘘（n = 1）、包裹性主动脉瘤破裂（n = 1）和急性主动脉夹层（n = 1）。内支架被部署到 0 区（n = 2）、1 区（n = 2）和 2 区（n = 5）。8 例 9 例患者的腔内去分支技术获得了技术上的成功，维持了分支灌注，没有内漏。围手术期发病率包括 1 例心肌梗死和 1 例导致患者死亡的中风。在随后的随访（2-25 个月）中，没有因烟囱支架导致的内漏。所有去分支的血管均保持原发性通畅。
腔内去分支技术允许在主动脉弓血管上计划延长胸主动脉内修复，同时进一步减少开放重建的需求。短期结果表明该方法具有技术可行性。长期结果仍未确定。
