Bosiers Michel J, Donas Konstantinos P, Mangialardi Nicola, Torsello Giovanni, Riambau Vincent, Criado Frank J, Veith Frank J, Ronchey Sonia, Fazzini Stefano, Lachat Mario
Department of Vascular and Endovascular Surgery, University of Münster, Münster; Department of Vascular Surgery, St. Franziskus-Hospital Münster, Münster, Germany.
Department of Vascular and Endovascular Surgery, University of Münster, Münster; Department of Vascular Surgery, St. Franziskus-Hospital Münster, Münster, Germany.
Ann Thorac Surg. 2016 Jun;101(6):2224-30. doi: 10.1016/j.athoracsur.2015.10.112. Epub 2016 Jan 12.
To study the performance of the chimney technique in the treatment of aortic arch pathologic conditions.
We retrospectively evaluated the clinical and procedural outcome data of patients undergoing endovascular treatment in the aortic arch by use of the chimney technique at four European centers between June 2002 and December 2014. The primary endpoint was technical success. The secondary endpoints were type I endoleak, 30-day mortality, stroke, primary patency of the chimney graft, and freedom from reintervention.
Ninety-five patients were included in the study. The underlying pathologic conditions were degenerative aneurysm (n = 45, 47.4%), type B aortic dissection (n = 30, 31.6%), dissecting aneurysm (n = 6, 6.5%), penetrating atherosclerotic ulcer (n = 5, 5.3%), type I endoleak after previous thoracic endovascular aortic repair (n = 6, 6.3%), and aortic embolic disease (n = 3, 3.2%). Twenty-one patients (22%) underwent arch-branch debranching before chimney graft implantation. The majority of patients were treated electively (n = 49, 51.6%). Forty-six patients (48.4%) underwent urgent placement of chimney grafts because of their symptoms (n = 25) or rupture (n = 21). Technical success was 89.5%. The 30-day mortality was 9.5% (9 patients). No aorta-related death was observed. A type Ia endoleak occurred in 10 patients (10.5%) intraoperatively, resolving spontaneously within the first 30 days in 50% of these cases. Major stroke was diagnosed in 2 patients (2%). Primary patency of the chimney grafts was 98%, and 5 patients (5.2%) required a reintervention.
The chimney technique in the aortic arch proved highly and predictably successful, with a low rate of reinterventions.
研究烟囱技术在治疗主动脉弓病变中的性能。
我们回顾性评估了2002年6月至2014年12月期间在四个欧洲中心接受主动脉弓血管内治疗并使用烟囱技术的患者的临床和手术结局数据。主要终点是技术成功。次要终点是I型内漏、30天死亡率、中风、烟囱移植物的原发性通畅率以及无需再次干预。
95例患者纳入研究。潜在病变情况为退行性动脉瘤（n = 45，47.4%）、B型主动脉夹层（n = 30，31.6%）、夹层动脉瘤（n = 6，6.5%）、穿透性动脉粥样硬化溃疡（n = 5，5.3%）、先前胸段血管内主动脉修复术后的I型内漏（n = 6，6.3%）以及主动脉栓塞性疾病（n = 3，3.2%）。21例患者（22%）在植入烟囱移植物前进行了弓部分支去分支术。大多数患者为择期治疗（n = 49，51.6%）。46例患者（48.4%）因症状（n = 25）或破裂（n = 21）而紧急植入烟囱移植物。技术成功率为89.5%。30天死亡率为9.5%（9例患者）。未观察到与主动脉相关的死亡。10例患者（10.5%）术中发生Ia型内漏，其中50%的病例在最初30天内自发缓解。2例患者（2%）被诊断为严重中风。烟囱移植物的原发性通畅率为98%，5例患者（5.2%）需要再次干预。
主动脉弓的烟囱技术被证明高度且可预测地成功，再次干预率低。
