Ferrer Ciro, Coscarella Carlo, Cao Piergiorgio
Unit of Vascular Surgery, Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy -
Vascular and Endovascular Surgery Unit, San Giovanni Addolorata Hospital, Rome, Italy.
J Cardiovasc Surg (Torino). 2018 Aug;59(4):547-553. doi: 10.23736/S0021-9509.18.10410-1. Epub 2018 Apr 11.
In the light of current evidence, endovascular repair of aortic arch pathologies with custom-made devices should be considered a valid alternative to decrease operative mortality and morbidity associated with open or hybrid repair. Today, two double inner branch devices are available on market. We report our single-center experience with Bolton double branch stent graft in the treatment of aortic arch disease.
Between 2013 and 2016, 15 high-risk patients with arch pathology were treated in our center with a custom-made branched device. Six of these received a Cook arch branched stent graft. Nine were treated with Bolton device. Among these, 2 with single branch model were excluded leaving a subgroup of 7 patients object of this study.
Out of the 7 male patients (mean age 76, range 70-85) included in the study, 2 died in-hospital after stroke and retrograde dissection, respectively. No other death, major complication or secondary intervention was recorded at a mean follow-up of 24 (min-max 6-53) months, neither any aneurysmal diameter evolution nor branch related complications.
Despite the small sample size, our results are in line with the early-published experiences about this technique. Endovascular repair of aortic arch disease with custom-made branched devices should always be considered to give high-risk patients a chance of repair.
根据目前的证据，使用定制装置对主动脉弓病变进行血管腔内修复应被视为一种有效的替代方法，以降低与开放或杂交修复相关的手术死亡率和发病率。如今，市场上有两种双内分支装置。我们报告了我们在使用博尔顿双分支支架移植物治疗主动脉弓疾病方面的单中心经验。
2013年至2016年期间，我们中心使用定制的分支装置对15例患有主动脉弓病变的高危患者进行了治疗。其中6例接受了库克主动脉弓分支支架移植物。9例接受了博尔顿装置治疗。在这些患者中，2例使用单分支模型的患者被排除，留下7例患者作为本研究的对象。
在纳入研究的7例男性患者（平均年龄76岁，范围70 - 85岁）中，分别有2例在术后因中风和逆行夹层分离在医院死亡。在平均24（最小 - 最大6 - 53）个月的随访中，未记录到其他死亡、重大并发症或二次干预，也未观察到动脉瘤直径变化或与分支相关的并发症。
尽管样本量较小，但我们的结果与早期发表的关于该技术的经验一致。对于高危患者，应始终考虑使用定制的分支装置对主动脉弓疾病进行血管腔内修复，以给予他们修复的机会。
