Wang Tun, Shu Chang, Li Quan-Ming, Li Ming, Li Xin, He Hao, Dardik Alan, Qiu Jian
Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China; Angiopathy Institute of Central South University, Changsha, China.
Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, China; Angiopathy Institute of Central South University, Changsha, China; Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China.
J Vasc Surg. 2017 Oct;66(4):1018-1027. doi: 10.1016/j.jvs.2017.02.035. Epub 2017 May 11.
The objective of this study was to summarize our initial experience using the double chimney technique to treat aortic arch diseases.
From December 2009 to October 2016, 23 patients with aortic arch diseases, including 20 acute aortic dissections, 2 aortic arch aneurysms, and 1 type I endoleak after thoracic endovascular aortic repair (TEVAR), were treated using a double chimney technique. An emergent operation was performed in only one patient with an acute aortic dissection for severe left lower extremity ischemia. All patients were observed after TEVAR with computed tomography scans at 2 weeks, at 3 and 6 months, and annually thereafter.
In all patients, aortic arch lesions were covered, and supra-aortic branches were patent without morbidity. In 22 patients, the innominate artery (IA) and left common carotid artery were reconstructed with the proximal landing zone in zone 0; in 1 patient, the left common carotid artery and left subclavian artery were reconstructed. During the procedure, there were three (13.0%) type I endoleaks. Chimney stent graft migration occurred in one (4.3%) patient perioperatively; compression of a chimney stent graft occurred in one (4.3%) patient 4 days after TEVAR. There were no type II endoleaks or perioperative mortality. Median follow-up was 28.0 ± 19.8 (range, 3-84) months, with no TEVAR-related deaths. Partial compression of the chimney stent graft in the IA occurred at 3 months after TEVAR in one (4.3%) patient; three patients had persistent but asymptomatic type I endoleaks.
TEVAR using a double chimney technique to reconstruct the supra-aortic branches provides a safe and minimally invasive alternative procedure associated with low postoperative mortality. The main perioperative complications include type I endoleak and compression of the chimney stent grafts in the IA. More experience with long-term results is needed to evaluate the effectiveness and durability of this advanced endovascular procedure.
本研究的目的是总结我们使用双烟囱技术治疗主动脉弓疾病的初步经验。
2009年12月至2016年10月，23例主动脉弓疾病患者，包括20例急性主动脉夹层、2例主动脉弓动脉瘤和1例胸主动脉腔内修复术（TEVAR）后I型内漏，采用双烟囱技术治疗。仅1例急性主动脉夹层患者因严重左下肢缺血接受了急诊手术。所有患者在TEVAR术后2周、3个月和6个月进行计算机断层扫描观察，此后每年观察一次。
所有患者的主动脉弓病变均被覆盖，主动脉弓上分支通畅，无并发症发生。22例患者的无名动脉（IA）和左颈总动脉在0区近端着陆区进行了重建；1例患者的左颈总动脉和左锁骨下动脉进行了重建。术中发生3例（13.0%）I型内漏。1例（4.3%）患者围手术期发生烟囱支架移植物移位；1例（4.3%）患者在TEVAR术后4天发生烟囱支架移植物受压。无II型内漏或围手术期死亡。中位随访时间为28.0±19.8（范围3 - 84）个月，无TEVAR相关死亡。1例（4.3%）患者在TEVAR术后3个月发生IA区烟囱支架移植物部分受压；3例患者存在持续性但无症状的I型内漏。
采用双烟囱技术重建主动脉弓上分支的TEVAR提供了一种安全、微创的替代手术，术后死亡率低。主要围手术期并发症包括I型内漏和IA区烟囱支架移植物受压。需要更多长期结果的经验来评估这种先进血管内手术的有效性和耐久性。
