McGill University, Division of Vascular Surgery, Jewish General Hospital, 3755 Cote-Ste-Catherine, Montreal, QC H3T1E2, Canada.
Eur J Vasc Endovasc Surg. 2012 May;43(5):525-32. doi: 10.1016/j.ejvs.2012.01.031. Epub 2012 Mar 3.
To present initial experience with a new modular transfemoral multibranched stent graft for treating aortic arch aneurysms.
Six patients, considered high risk for open surgery, were treated with custom made branched stent grafts. All patients had a staged left carotid subclavian bypass before the endovascular procedure. Each branched graft had a 12 mm side branch for the innominate artery and an 8 mm side branch for the left common carotid artery.
Four patients out of six had uneventful placement of the prostheses, with successful exclusion of their aneurysms. One patient developed a type I endoleak that was managed successfully with coiling and gluing of the aneurysm sac. In one patient, cannulation of the innominate branch was unsuccessful and an extra-anatomic bypass was necessary to perfuse the right carotid and vertebral arteries. This patient developed a stroke, while one more suffered a right cerebellar infarct.
We have demonstrated the technical feasibility of a modular transfemoral branched stent graft for treatment of aortic arch aneurysms. The method is relatively safe based on initial experience. More cases and long-term follow up are necessary to evaluate the efficacy and safety of this new device.
介绍一种新的模块化经股多分支支架移植物治疗主动脉弓动脉瘤的初步经验。
6 名被认为开放手术风险较高的患者接受了定制的分支支架移植物治疗。所有患者在血管内治疗前均进行了分期左颈总锁骨下旁路手术。每个分支移植物都有一个 12 毫米的分支用于无名动脉，一个 8 毫米的分支用于左侧颈总动脉。
6 名患者中有 4 名成功地放置了假体，动脉瘤得到了成功的隔绝。1 名患者发生了 I 型内漏，通过对动脉瘤囊进行弹簧圈和胶黏处理成功得到了治疗。1 名患者无名动脉分支的插管不成功，需要进行额外的解剖旁路以灌注右侧颈动脉和椎动脉。该患者发生了中风，还有 1 名患者发生了右侧小脑梗死。
我们已经证明了模块化经股分支支架移植物治疗主动脉弓动脉瘤的技术可行性。根据初步经验，该方法相对安全。需要更多的病例和长期随访来评估这种新设备的疗效和安全性。
