Kanaoka Yuji, Ohki Takao, Toya Naoki, Ishida Atsushi, Tachihara Hiromasa, Hirayama Shigeki, Kurosawa Koji, Sumi Makoto, Ohta Hiroki, Kaneko Kenjiro
Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan.
Ann Vasc Dis. 2012;5(1):21-9. doi: 10.3400/avd.oa.11.01011. Epub 2012 Jan 31.
Endovascular aneurysm repair has gained widespread acceptance, and there has been a significant increase in the number of aneurysms treated with stent grafts. However, the endovascular technique alone is often not appropriate for anatomically complex aneurysms involving the neck branches. We used the TAG stent for thoracic aortic aneurysms (TAA), and report our initial results.
We deployed 80 TAG stents in 65 patients electively treated with TAA between June 2006 and June 2008. Thoracic endovascular aneurysm repair (TEVAR) was performed in 45 cases of descending aortic aneurysm with no morbidity or mortality. A combination of open surgery and TEVAR was performed in 11 out of 20 cases with aneurysms of the aortic arch. The prior total arch replacement and elephant trunk procedure was performed in 3 cases with dilated ascending aorta, total debranching from ascending aorta with sternotomy in 5, and carotid-carotid artery crossover bypass in 3 cases. Meanwhile, TEVAR with coverage of the left subclavian artery was performed in the remaining 9 distal arch cases. In 3 cases with extremely short necks, a 0.018" guide wire was inserted percutaneously in a retrograde manner through the common carotid artery (CCA) into the ascending aorta to place the stent graft in close proximity to the CCA (wire protection). In 1 of these 3 cases, the TAG stent was deployed through the CCA, and the 0.018" guide wire was used to deliver a balloon-expandable stent in order to restore the patency of the CCA. In arch and distal arch aneurysm cases, perioperative mortality and the incidence of stroke were both 5.0%; dissection of the ascending aorta was seen in one case (5.0%).
As treatment for descending aortic aneurysms, TEVAR can replace conventional open repair. However, TEVAR for arch aneurysms has some problems, and further improvement is necessary. (English Translation of Jpn J Vasc Surg 2010; 19: 547-555.).
血管内动脉瘤修复术已得到广泛认可，采用支架移植物治疗的动脉瘤数量显著增加。然而，单纯的血管内技术通常不适用于涉及颈部分支的解剖结构复杂的动脉瘤。我们使用TAG支架治疗胸主动脉瘤（TAA），并报告我们的初步结果。
2006年6月至2008年6月期间，我们为65例择期治疗的TAA患者植入了80枚TAG支架。45例降主动脉瘤患者接受了胸主动脉腔内修复术（TEVAR），无并发症或死亡发生。20例主动脉弓部动脉瘤患者中，11例采用了开放手术与TEVAR相结合的方法。3例升主动脉扩张患者先行全弓置换及象鼻手术，5例经胸骨切开术从升主动脉完全去分支，3例行动脉-动脉交叉搭桥术。同时，其余9例远端弓部动脉瘤患者行覆盖左锁骨下动脉的TEVAR。3例颈部极短的患者，经皮逆行将0.018英寸导丝通过颈总动脉（CCA）插入升主动脉，使支架移植物靠近CCA（导丝保护）。这3例患者中有1例通过CCA植入TAG支架，并使用0.018英寸导丝输送球囊扩张支架以恢复CCA的通畅。在主动脉弓和远端弓部动脉瘤病例中，围手术期死亡率和卒中发生率均为5.0%；1例（5.0%）出现升主动脉夹层。
作为降主动脉瘤的治疗方法，TEVAR可替代传统的开放修复术。然而，TEVAR治疗主动脉弓部动脉瘤存在一些问题，需要进一步改进。（《日本血管外科学杂志》2010年英文译文；19: 547 - 555.）
