1 Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Circolo University Hospital, Varese, Italy.
2 Vascular Surgery, Department of Surgery, Policlinico Tor Vergata, Rome, Italy.
J Endovasc Ther. 2018 Dec;25(6):740-749. doi: 10.1177/1526602818802581. Epub 2018 Oct 4.
To analyze the results of isolated left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR) using carotid-subclavian bypass (CSbp) or chimney grafts (CGs).
A retrospective multicenter, observational study identified 73 patients (mean age 68±13 years, range 22-87; 56 men) with acute or chronic thoracic aortic lesions who underwent TEVAR with isolated LSA revascularization using either CSbp (n=42) or CGs (n=31) from January 2010 and February 2017. Primary endpoints were TEVAR-related mortality, postoperative stroke, freedom from type Ia endoleak, and LSA patency.
Primary technical success was achieved in all cases. Early TEVAR-related mortality was 4.2% (CSbp 2% vs CG 6%, p=0.571). Two (3%) patients had major ischemic strokes (one in each group). Mean follow-up was 24±21 months (range 1-72; median 15). Estimated freedom from TEVAR-related mortality was 93%±3% (95% CI 84.3% to 97.0%) at 12 and 36 months, with no significant difference between CSbp and CG (p=0.258). Aortic reintervention did not differ between the groups (CSbp 5% vs CG 6%, p=0.356); nor did freedom from type Ia endoleak (CSbp 98% vs CG 87%, p=0.134). Gutter-related endoleaks occurred in 4 (13%) CG patients, but none of the patients experienced sac enlargement or the need for reintervention and none died. Primary patency of the LSA was 100% for the entire group during the observation period.
In our experience, LSA revascularization proved most satisfactory and equally effective with both the CSbp and CG techniques, without discernible differences at midterm follow-up.
分析在胸主动脉腔内修复术（TEVAR）中使用颈动脉-锁骨下旁路（CSbp）或烟囱移植物（CGs）对孤立左锁骨下动脉（LSA）进行血运重建的结果。
一项回顾性多中心观察性研究纳入了 73 名（平均年龄 68±13 岁，范围 22-87 岁；56 名男性）接受 TEVAR 治疗的急性或慢性胸主动脉病变患者，这些患者在 2010 年 1 月至 2017 年 2 月期间使用 CSbp（n=42）或 CGs（n=31）进行了孤立 LSA 血运重建。主要终点是 TEVAR 相关死亡率、术后中风、无ⅠA型内漏和 LSA 通畅性。
所有病例均达到了主要技术成功。早期 TEVAR 相关死亡率为 4.2%（CSbp 为 2%，CG 为 6%，p=0.571）。有 2 名（3%）患者发生了严重的缺血性中风（每组 1 例）。平均随访时间为 24±21 个月（范围 1-72；中位数 15）。12 个月和 36 个月时，TEVAR 相关死亡率的估计无事件生存率分别为 93%±3%（95%CI 84.3%至 97.0%），CSbp 与 CG 之间无显著差异（p=0.258）。两组之间主动脉再干预无差异（CSbp 为 5%，CG 为 6%，p=0.356）；ⅠA型内漏无事件生存率也无差异（CSbp 为 98%，CG 为 87%，p=0.134）。4 名（13%）CG 患者发生了 gutter 相关内漏，但没有患者发生了囊腔扩大或需要再干预，也没有患者死亡。整个观察期间，LSA 的初始通畅率为 100%。
根据我们的经验，CSbp 和 CG 技术均可对孤立的 LSA 进行血运重建，在中期随访中没有明显差异，且结果均令人满意，同样有效。
