Pecoraro F, Lachat M, Cayne N S, Pakeliani D, Rancic Z, Puippe G, Criado F J, Pfammatter T, Veith F J, Krüger B, Neff T A
Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland; University of Palermo, Vascular Surgery Unit, AOUP "P. Giaccone", Palermo, Italy.
Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland.
Eur J Vasc Endovasc Surg. 2017 Sep;54(3):295-302. doi: 10.1016/j.ejvs.2017.06.014. Epub 2017 Jul 25.
Report mid-term outcomes of thoracic endovascular aneurysm repair (TEVAR) with chimney and periscope grafts (CPG) in supra-aortic branches (SAB).
Retrospective analysis, from October 2009 to May 2014, of patients with aneurysms requiring TEVAR with zone 0/1/2 proximal landing in association with at least one CPG in the SAB. All patients were considered at high risk for conventional surgery. Peri-operative mortality and morbidity, retrograde type A dissection, maximum aortic transverse diameter (TD) and its post-operative evolution, endoleak, survival, freedom from cardiovascular re-interventions, and CPG freedom from occlusion during the follow-up were analysed.
Forty-one patients (28.05% EuroScore II) with thoraco-abdominal aortic aneurysm (17%), arch aneurysm (39%), descending aneurysm (34%), and aneurysm extending from the arch to the visceral aorta (10%) were included. Fifteen (37%) patients were treated non-electively. Fifty-nine SABs were treated with the CPG technique: one, two, three, and four CPG were employed in 71%, 19%, 5%, and 5% of patients, respectively. The proximal landing was in zone 0 in 49% of patients, zone 1 in 17%, and zone 2 in 34%. Technical success was 95%. Peri-operative complications and neurological events were registered in six (14.6%) patients and there were 5 deaths (12%). At a median follow-up of 21.2 (mean 22, SD 18; range 0-65) months, type I/III endoleaks were registered in three (7%) cases and re-intervention in six (15%) patients. A significant aneurysm sac shrinkage (p<.001) was reported at mean follow-up and no significant aneurysm sac increase (>5 mm). The estimated 2 year survival, freedom from re-intervention, freedom from endoleak, and freedom from branch occlusion were 75%, 77%, 86%, and 96%, respectively.
The chimney and periscope grafts technique was shown to be safe in aortic aneurysm disease involving the supra aortic branches, even in an emergency setting using off the shelf devices. Mid-term follow-up results in this high risk population are good, but longer follow-up is mandatory before this technique is used in intermediate-risk patients.
报告采用烟囱和潜望镜移植物（CPG）治疗主动脉弓上分支（SAB）动脉瘤的胸主动脉腔内修复术（TEVAR）的中期结果。
回顾性分析2009年10月至2014年5月期间需要进行TEVAR治疗且近端锚定区为0/1/2区并伴有至少一个SAB的CPG的动脉瘤患者。所有患者均被认为常规手术风险高。分析围手术期死亡率和发病率、逆行A型夹层、主动脉最大横径（TD）及其术后变化、内漏、生存率、无心血管再次干预情况以及随访期间CPG无闭塞情况。
纳入41例患者（欧洲心脏手术风险评估系统II评分为28.05%），其中胸腹主动脉瘤患者17%，主动脉弓动脉瘤患者39%，降主动脉瘤患者34%，从主动脉弓延伸至内脏主动脉的动脉瘤患者10%。15例（37%）患者为非择期治疗。采用CPG技术治疗了59个SAB：分别有71%、19%、5%和5%的患者使用了1个、2个、3个和4个CPG。49%的患者近端锚定区为0区，17%为1区，34%为2区。技术成功率为95%。6例（14.6%）患者出现围手术期并发症和神经系统事件，5例（12%）死亡。中位随访时间为21.2（平均22，标准差18；范围0 - 65）个月，3例（7%）患者出现I/III型内漏，6例（15%）患者需要再次干预。平均随访时报告动脉瘤囊显著缩小（p <.001），且动脉瘤囊无显著增大（>5 mm）。估计2年生存率、无再次干预率、无内漏率和无分支闭塞率分别为75%、77%、86%和96%。
烟囱和潜望镜移植物技术在涉及主动脉弓上分支的主动脉瘤疾病中显示出安全性，即使在使用现成器械的紧急情况下也是如此。该高风险人群的中期随访结果良好，但在将该技术应用于中风险患者之前，必须进行更长时间的随访。
