Departments of Cardiothoracic Surgery and, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
J Endovasc Ther. 2011 Jun;18(3):350-4. doi: 10.1583/10-3278.1.
To describe a technique for transapical wire-assisted endograft deployment under rapid ventricular pacing for a type B dissection involving the proximal left subclavian artery and extending to the aortic bifurcation.
A 58-year-old man presented with a symptomatic thoracic aneurysm as a complication of a chronic type B dissection, with a short proximal neck in zone 1. After arch vessel debranching, the patient underwent endoluminal repair with deployment of a closed web, tapered Valiant thoracic endograft over a through-and-through wire from the left groin to the apex of the left ventricle, using rapid ventricular pacing to reduce cardiac output. The remaining dissected aorta was covered with a second Valiant endograft down to the distal third of the descending thoracic aorta and bare Z stents down to the aortic bifurcation to re-expand the true lumen. A freeflow Valiant endograft was deployed as a proximal extension to treat a proximal type I endoleak. The recovery was complicated by retrograde type A aortic dissection, considered secondary to the bare stent. The complication was repaired surgically; postoperative computed tomography after recovery was unremarkable.
Transapical wire-assisted deployment with rapid ventricular pacing is feasible and may provide improved stability for stenting within the aortic arch. The use of a stent-graft with a proximal bare stent is associated with a higher risk of retrograde extension of the dissection and warrants lifelong imaging follow-up.
描述一种在快速心室起搏下经心尖途径辅助输送覆膜支架的技术，用于治疗累及近端左锁骨下动脉并延伸至主动脉分叉的 B 型夹层。
一名 58 岁男性因慢性 B 型夹层的并发症出现胸主动脉瘤，近端 1 区短颈。在弓部血管分支重建后，患者接受了腔内修复，使用经左腹股沟至左心室心尖部的贯穿导丝，输送封闭网眼、锥形 Valiant 胸主动脉覆膜支架，同时进行快速心室起搏以减少心输出量。剩余的夹层主动脉被第二个 Valiant 覆膜支架覆盖，直至降主动脉的远端三分之一，裸 Z 支架覆盖至主动脉分叉以重新扩张真腔。一个自由流动的 Valiant 覆膜支架作为近端延伸部分用于治疗近端 I 型内漏。恢复过程中出现逆行性 A 型主动脉夹层，考虑与裸支架有关。该并发症通过手术修复；恢复后的术后计算机断层扫描无明显异常。
经心尖途径辅助输送联合快速心室起搏是可行的，可能为主动脉弓内支架提供更好的稳定性。使用带有近端裸支架的支架移植物与夹层逆行扩展的风险增加相关，需要终身影像学随访。
