Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
J Endovasc Ther. 2011 Aug;18(4):471-6. doi: 10.1583/11-3506R.1.
To report off-label use of approved off-the-shelf endografts with no modification to the devices for the management of thoracoabdominal aneurysms (TAAA).
The parallel endograft octopus technique is demonstrated in a 68-year-old woman with a past history of open TAAA repair with a patch reimplant of the visceral vessels who now presented with back pain. Non-contrast computed tomography revealed a 6.8-cm aneurysm of the visceral segment involving the celiac trunk, superior mesenteric artery (SMA), and right renal artery. As she was at high risk for redo surgery due to significant pulmonary dysfunction, she was an ideal candidate for a branched graft, but she could not travel to an investigational site for a custom graft. At surgery, 4 sheaths were introduced, 2 retrograde (18-F DrySeal) and 2 (8-F) antegrade, via the femoral arteries. The 18-F sheaths on both sides were connected to the 8-F sheaths for continued limb perfusion. Via an axillary conduit, a 12-F, 80-cm sheath was introduced into the proximal thoracic aorta over a stiff wire. Subsequently, two 28-mm Excluder endografts were introduced via the bilateral 18-F femoral sheaths and positioned side by side in the descending thoracic aorta such that the lower end of the Excluder limbs were positioned ≥2 cm above the target visceral vessels. Viabahn stent-grafts were then deployed in the celiac axis, SMA, and right renal artery from the axillary conduit. Subsequently, a 23-mm Excluder was deployed within the distal end of the upsized limb and extended to both common iliac arteries. Imaging at 6 months demonstrated no endoleaks, with good flow to all visceral vessels.
The parallel endograft octopus technique described here, which has been applied successfully in 9 cases thus far, is a relatively simple method using currently available devices with no requirement for device modification or customization. Although this technique shows promise, long-term data will be required to prove efficacy. This technique demonstrates a concept for future development of branched graft technology.
报告在不修改设备的情况下，将已批准的现成内置移植物用于胸主动脉瘤（TAAA）的治疗。
本文介绍了一种在一位 68 岁女性中应用的平行内置移植物章鱼技术。该女性曾行开放 TAAA 修复术，其中内脏血管段采用补片重新植入，现出现背痛。非增强 CT 显示内脏段 6.8cm 大小的动脉瘤，累及腹腔干、肠系膜上动脉（SMA）和右肾动脉。由于她存在严重的肺功能障碍，再次手术风险很高，因此是分支移植物的理想人选，但她无法前往研究中心使用定制移植物。在手术中，通过股动脉引入 4 个鞘管，2 个逆行（18-F DrySeal）和 2 个顺行（8-F）。双侧 18-F 鞘管连接到 8-F 鞘管，以保持肢体灌注。通过腋部导管将 12-F、80cm 鞘管引入近端胸主动脉，通过硬导丝。随后，通过双侧 18-F 股动脉鞘管引入两个 28-mm Excluder 内置移植物，并并排放置在降主动脉中，使 Excluder 分支的下端位于目标内脏血管上方≥2cm。随后从腋部导管向腹腔干、SMA 和右肾动脉置入 Viabahn 支架移植物。随后，将 23-mm Excluder 置于扩大分支的远端，并延伸至双侧髂总动脉。6 个月的影像学检查显示无内漏，所有内脏血管均有良好的血流。
目前已成功应用于 9 例患者的这种平行内置移植物章鱼技术是一种相对简单的方法，使用了目前可用的设备，不需要设备修改或定制。虽然该技术显示出了一定的前景，但需要长期数据来证明其疗效。该技术展示了分支移植物技术的未来发展理念。
