Di Tommaso Luigi, Giordano Raffaele, Di Tommaso Ettorino, Di Palo Giusi, Iannelli Gabriele
Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy.
J Thorac Dis. 2018 Nov;10(11):6097-6106. doi: 10.21037/jtd.2018.10.51.
Here we evaluate the usefulness of transfemoral uncovered stent implantation to avoid secondary conventional surgery for residual type A aortic dissection (TAAD) of the aortic arch after ascending aorta replacement.
From June 2009 to April 2015, 11 patients were treated with transfemoral implantation of uncovered stents in the aortic arch after surgical replacement of ascending aorta performed on average 4.7±2.3 years earlier. An enlarged dissected aortic arch or a dangerous median growth of more than 5 mm/yr or impending rupture presenting as chest pain were indications for treatment. The dissected aortic tracts diameter must not exceed 45 mm. Five patients (45.5%) were treated with Djumbodies Dissection System, 6 patients (54.5%) with Jotec E-XL aortic stent.
There were no perioperative deaths or permanent neurologic complications. Primary procedural success was obtained in all patients and the residual TAAD in aortic arch was obliterated, with disappearance of the false lumen. Median intensive care unit (ICU) stay was 24 hours; post-operative hospital stay was 5.2±1.4 days. One death, not aortic related, occurred during follow-up period (mean 5.2±1.9 years). Descending thoracic aorta diameter significantly increased in 3 patients (27.3%): one patient (9.0%) needed a secondary conventional surgery, the other 2 (18.2%) of a distal extension with PETTICOAT approach.
Endovascular approach with uncovered metal bare stent is surely an evolving strategy to perform a purely endovascular treatment, indicated only for treatment of an aortic arch with a diameter of less than 40 or 45 mm, to avoid progressive thoracic aortic dilatation and/or rupture.
在此，我们评估经股动脉植入无覆膜支架以避免对升主动脉置换术后残留的主动脉弓A型主动脉夹层（TAAD）进行二次传统手术的有效性。
2009年6月至2015年4月，11例患者在平均4.7±2.3年前进行升主动脉置换术后，接受了经股动脉在主动脉弓植入无覆膜支架的治疗。主动脉弓扩大、夹层或危险的中径每年增长超过5mm或因胸痛提示即将破裂是治疗指征。夹层主动脉段直径不得超过45mm。5例患者（45.5%）接受了Djumbodies夹层系统治疗，6例患者（54.5%）接受了Jotec E-XL主动脉支架治疗。
围手术期无死亡或永久性神经并发症。所有患者均获得了主要手术成功，主动脉弓残留的TAAD被消除，假腔消失。重症监护病房（ICU）中位住院时间为24小时；术后住院时间为5.2±1.4天。随访期间发生1例与主动脉无关的死亡（平均5.2±1.9年）。3例患者（27.3%）降主动脉直径显著增加：1例患者（9.0%）需要进行二次传统手术，另外2例（18.2%）采用PETTICOAT方法进行远端扩展。
使用无覆膜金属裸支架的血管内治疗方法无疑是一种不断发展的策略，仅适用于直径小于40或45mm的主动脉弓的纯血管内治疗，以避免胸主动脉进行性扩张和/或破裂。
