Youssef Marwan, Salem Oroa, Dünschede Fritz, Vahl Christian F, Dorweiler Bernhard
Department of Cardiothoracic and Vascular Surgery, Medical Center of the Johannes Gutenberg-University Mainz, Germany.
Thorac Cardiovasc Surg. 2018 Apr;66(3):233-239. doi: 10.1055/s-0037-1602376. Epub 2017 May 2.
To analyze utilization of a perfusion branch for temporary sac perfusion to reduce the spinal cord ischemia (SCI) in the endovascular repair of thoracoabdominal aortic aneurysms (TAAAs).
Between January 2012 and August 2016, 30 patients (18, men; median age 72 years) were treated for TAAAs with total endovascular repair using customized branched/fenestrated endografts in our institution. The median aneurysm size was 6.6 cm. Types of TAAA were: type I, 9 (30%), type II, 5 (16.6%), type III, 4 (13.3%), type IV, 6 (20%), and type V, 6 (20%). Ten patients received a perfusion branch to create an intentional endoleak, which was occluded with vascular plugs in mean interval time of 8.2 weeks (range: 6-10). Staged procedure and automated cerebrospinal fluid drainage were used in 23 (77%) and 24 (80%) patients, respectively.
The technical success was 97%; 107 renovisceral target vessels were revascularized (32 fenestrations, 75 branches). At the time of the planned reinterventions, the mean arterial pressure (MAP) gradients were measured between the temporarily perfused aneurysm sac and the aortic endografts, and they were significantly higher (mean gradients 42.5 ± 10 mm Hg; range: 30-60) within the aortic grafts. The in-hospital and 30-day mortality was 3.3%. The incidence of postoperative SCI was 3/20 (15%) in the standard group and 0% in the group of the perfusion branch ( = 0.28). The mean follow-up was 12 months (range: 2-51).
We experience that the use of a dedicated perfusion branch is feasible and may serve as protective adjunct to reduce the risk of SCI in endovascular treatment of TAAA. The risk of rupture in interval appears to be low. Larger series and multicenter studies are warranted to corroborate these results.
分析在胸腹主动脉瘤（TAAA）腔内修复术中利用灌注分支进行临时囊袋灌注以减少脊髓缺血（SCI）的情况。
2012年1月至2016年8月期间，在我们机构中，30例患者（18例男性；中位年龄72岁）接受了使用定制分支/开窗型腔内移植物进行的TAAA全腔内修复治疗。动脉瘤中位大小为6.6厘米。TAAA的类型为：I型9例（30%），II型5例（16.6%），III型4例（13.3%），IV型6例（20%），V型6例（20%）。10例患者接受了灌注分支以制造有意的内漏，平均8.2周（范围：6 - 10周）后用血管塞封堵。分别有23例（77%）和24例（80%）患者采用了分期手术和自动脑脊液引流。
技术成功率为97%；107条肾内脏靶血管实现了血运重建（32个开窗，75个分支）。在计划再次干预时，测量了临时灌注的动脉瘤囊与主动脉腔内移植物之间的平均动脉压（MAP）梯度，主动脉移植物内的梯度明显更高（平均梯度42.5±10毫米汞柱；范围：30 - 60）。住院和30天死亡率为3.3%。标准组术后SCI发生率为3/20（15%），灌注分支组为0%（P = 0.28）。平均随访时间为12个月（范围：2 - 51个月）。
我们经验表明，使用专用灌注分支是可行的，并且在TAAA腔内治疗中可作为降低SCI风险的保护性辅助手段。间隔期破裂风险似乎较低。需要更大样本系列和多中心研究来证实这些结果。
