Vascular Centre, Augusta Hospital and Catholic Hospital Group Düsseldorf, Düsseldorf, Germany.
Vascular Centre, Augusta Hospital and Catholic Hospital Group Düsseldorf, Düsseldorf, Germany.
J Vasc Surg. 2014 Jun;59(6):1562-9. doi: 10.1016/j.jvs.2013.12.044. Epub 2014 Mar 7.
The sandwich technique is an endovascular off-the-shelf solution for patients with thoracoabdominal aortic aneurysms (TAAAs). In a sandwich configuration, the chimney stent runs in the middle of a space created by two or three aortic endografts.
All patients with TAAAs who were treated with the sandwich technique were included in the study. Self-expanding Viabahn grafts (W. L. Gore and Associates Inc, Flagstaff, Ariz) were used as parallel grafts in the renal arteries and visceral vessels. Caudad-facing chimney grafts were used for the visceral arteries and cephalad-facing periscope grafts for the renal arteries.
During the study period, 32 patients with TAAAs were treated with sandwich grafts. Indication for the procedure in 43% was an acute onset of symptoms, including two patients with a rupture and a retroperitoneal hematoma. Three patients required an additional debranching procedure. A total of 104 chimney grafts were implanted. Two patients died postoperatively because of the operation. Major adverse events were recorded in five patients, including one patient with persistent paraplegia and two with permanent renal failure requiring dialysis. The incidence of chimney graft occlusion was higher in patients with three or four parallel grafts than in those with two chimney grafts only. Patients with chronic dissections had a 12-times higher incidence of chimney graft occlusion than aneurysm patients. The number of patients with type I or III endoleaks was higher in the group with three or four parallel grafts.
The sandwich technique is an off-the-shelf endovascular alternative to treat patients with TAAAs in an emergent setting. The combination of chimney grafts with a periscope configuration enables a rapid endovascular aneurysm exclusion with acceptable midterm results.
夹心技术是一种治疗胸腹主动脉瘤（TAAA）的血管内即用型解决方案。在夹心配置中，烟囱支架位于两个或三个主动脉内移植物之间的空间中间。
本研究纳入了所有接受夹心技术治疗的 TAAA 患者。自膨式 Viabahn 移植物（W. L. Gore and Associates Inc，Flagstaff，Ariz）用作肾动脉和内脏血管的平行移植物。顺行烟囱移植物用于内脏动脉，逆行望远镜移植物用于肾动脉。
在研究期间，32 例 TAAA 患者接受了夹心移植物治疗。43%的患者因急性症状而接受该手术，包括 2 例破裂和腹膜后血肿。3 例患者需要额外的去分支手术。共植入 104 个烟囱移植物。2 例患者术后死亡。5 例患者记录了主要不良事件，包括 1 例持续性截瘫和 2 例需要透析的永久性肾衰竭。在接受三或四个平行移植物的患者中，烟囱移植物闭塞的发生率高于仅接受两个烟囱移植物的患者。慢性夹层的患者烟囱移植物闭塞的发生率是动脉瘤患者的 12 倍。在三或四个平行移植物组中，I 型或 III 型内漏的患者更多。
夹心技术是一种即用型的血管内替代方法，可用于治疗紧急情况下的 TAAA 患者。烟囱移植物与望远镜配置的结合可实现快速血管内动脉瘤排除，并获得可接受的中期结果。
