Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany; Department of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany.
Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany; Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany.
Ann Thorac Surg. 2018 Feb;105(2):587-591. doi: 10.1016/j.athoracsur.2017.08.029. Epub 2017 Dec 2.
To report a new technique for diameter correction in patients after thoracic endovascular aortic repair (TEVAR) with large stent-grafts using the Vascutek Siena 4-branch collared prosthesis (Vascutek Terumo, Inchinnan, Scotland, UK) in patients undergoing thoracoabdominal (TA) aortic replacement.
Within a 24-month period, 39 patients underwent TA replacement at our center. Of these, 6 patients had undergone previous TEVAR with large stent-grafts (42 to 48 mm diameter). Indications for TEVAR were aneurysm formation in 3 patients and residual type B aortic dissection (status post repair of type A dissection) in 3 patients. In these patients, the Vascutek Siena 4-branch prosthesis was used in a reversed fashion, removing the elephant trunk portion and using the sewing collar for diameter correction at the anastomotic site.
No 30-day mortality and no stroke or symptomatic spinal cord ischemia was observed. Median diameter of the TEVAR graft at the anastomotic site was 44 mm. Median size of the Siena graft used was 26 mm. Diameter correction was successfully achieved in all patients by tailoring the sewing collar of the Siena 4-branch prosthesis to the individual need according to the diameter of the distal end of the stent-graft.
Using the sewing collar of the Vascutek Siena 4-branch prosthesis for diameter correction in patients undergoing TA replacement after previous TEVAR with large stent-grafts adds a useful adjunct to the armamentarium of options in a growing patient population.
报道一种在先前接受大口径支架移植的胸主动脉腔内修复术（TEVAR）的患者中，使用 Vascutek Siena 4 分支带袖套人工血管（Vascutek Terumo，Inchinnan，苏格兰，英国）进行胸腹主动脉（TA）置换术时进行直径校正的新技术。
在 24 个月的时间内，我们中心有 39 例患者接受了 TA 置换术。其中 6 例患者先前接受过大口径支架移植（直径 42 至 48 毫米）。TEVAR 的适应证为 3 例患者出现动脉瘤形成和 3 例患者残留的 B 型主动脉夹层（A型夹层修复后）。在这些患者中，Vascutek Siena 4 分支人工血管被反向使用，去除象鼻部分，并使用缝合袖套在吻合部位进行直径校正。
无 30 天死亡，无卒中或症状性脊髓缺血。吻合部位 TEVAR 移植物的中位直径为 44 毫米。使用的 Siena 人工血管的中位尺寸为 26 毫米。通过根据支架移植物远端的直径来裁剪 Siena 4 分支人工血管的缝合袖套，成功地在所有患者中实现了直径校正。
在先前接受大口径支架移植的 TEVAR 后进行 TA 置换的患者中，使用 Vascutek Siena 4 分支人工血管的缝合袖套进行直径校正，为不断增长的患者人群提供了一种有用的选择。
