From the Department of Diagnostic and Interventional Radiology (F.W., N.H., T.A.B., R.K.) and Department of Cardiothoracic and Thoracic Vascular Surgery (R.L.), University Hospital of Wuerzburg, Oberduerrbacherstr 6, D-97070 Wuerzburg, Germany; and Clinic for Radiology and Nuclear Medicine, Luebeck, Germany (J.P.G.).
Radiology. 2015 Sep;276(3):862-72. doi: 10.1148/radiol.2015140520. Epub 2015 Apr 22.
To evaluate the feasibility, effectiveness, and safety of using a commercially available reentry catheter with fluoroscopic guidance to gain controlled target lumen reentry for fenestration in patients with aortic dissection.
This retrospective study was approved by the local institutional review board; informed consent was waived. Between April 2009 and December 2013, 13 consecutive patients (10 men and three women; mean age, 51.2 years; range, 30.0-77.0 years; mean age of women, 47.0 years; range, 30.0-69.0 years; mean age of men, 52.4 years; range, 35.0-77.0 years) with aortic dissection and spinal (n = 4), renal (n = 7), mesenteric (n = 2), and/or iliofemoral (n = 9) malperfusion syndrome were included. All patients received target lumen reentry by means of balloon fenestration of the aortic dissection flap. A reentry catheter was used for fluoroscopically guided puncture of the target lumen. Technical success, clinical outcome, Stanford type of dissection, procedure time, number of fenestrations of the intimal flap per patient, necessity of additional aortic stent-graft implantation and/or placement of a bare metal stent, complications, and follow-up images were evaluated. Pre- and postinterventional systolic blood pressure gradients between the true lumen and the false lumen were compared (Wilcoxon signed-rank test). Safety of the reentry catheter maneuver was estimated with the Clopper-Pearson method.
Use of the reentry catheter was technically successful in all 13 (100%) patients and clinically successful in 10 of 13 (77%) patients. Four patients had type A and nine had type B dissection. The mean clinical follow-up period was 14.2 months. Median procedure time was 71 minutes. In four patients, fenestration of the intimal flap was performed twice. Three patients underwent additional aortic stent grafting, four patients underwent placement of an iliofemoral stent, and one patient underwent placement of a carotid artery stent. Blood pressure gradients between the true lumen and the false lumen were significantly reduced (P = .0313). One patient who had a combination of syndromes died of multiorgan failure.
The applied commercially available reentry catheter seems to be a reliable and safe tool that may be useful for gaining target lumen reentry with reasonably good clinical outcomes.
评估使用市售再进入导管在透视引导下对主动脉夹层患者进行控制性靶腔再进入以进行开窗的可行性、有效性和安全性。
本回顾性研究获得了当地机构审查委员会的批准；豁免了知情同意。2009 年 4 月至 2013 年 12 月，连续纳入 13 例主动脉夹层伴脊髓（n = 4）、肾（n = 7）、肠系膜（n = 2）和/或髂股（n = 9）灌注不良综合征的患者。所有患者均接受主动脉夹层瓣球囊开窗以实现靶腔再进入。使用再进入导管进行透视引导下的靶腔穿刺。评估技术成功率、临床结局、Stanford 类型的夹层、手术时间、每位患者的内瓣开窗数量、是否需要额外的主动脉支架移植和/或放置裸金属支架、并发症和随访图像。比较真腔和假腔之间的术前和术后收缩压梯度（Wilcoxon 符号秩检验）。使用 Clopper-Pearson 方法估计再进入导管操作的安全性。
13 例（100%）患者均成功使用再进入导管，13 例（77%）患者临床成功。4 例患者为 A 型，9 例为 B 型夹层。平均临床随访时间为 14.2 个月。中位数手术时间为 71 分钟。4 例患者进行了两次内瓣开窗。3 例患者接受了额外的主动脉支架移植，4 例患者接受了髂股支架的放置，1 例患者接受了颈动脉支架的放置。真腔和假腔之间的血压梯度显著降低（P =.0313）。1 例合并综合征的患者死于多器官衰竭。
应用的市售再进入导管似乎是一种可靠且安全的工具，对于获得靶腔再进入并获得相当好的临床结果可能有用。
