Department of Medical Education, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Eur J Cardiothorac Surg. 2019 Sep 1;56(3):587-594. doi: 10.1093/ejcts/ezz049.
This study aimed to evaluate the efficacy and safety of a handmade fenestrated stent graft over an aortic stent graft for preserving the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR).
From July 2015 to October 2018, a total of 32 consecutive patients with various thoracic aortic pathologies who underwent TEVAR in which handmade fenestration over a thoracic aortic stent graft was used for LSA were included. Outcomes including technical success, procedure-related complications, perioperative mortality and morbidity and graft patency were analysed.
Twenty-four patients (75.00%) presented with aortic dissection, 5 patients (15.63%) with thoracic aortic aneurysm and 2 patients (6.25%) with penetrating aortic ulcer; 1 patient (3.13%) required re-TEVAR due to endoleak and sac expansion from previous TEVAR for thoraco-abdominal aneurysm. TEVAR was performed in a zone 2 landing with single fenestration for LSA (26 patients, 81.25%), zone 1 landing with double fenestration for both LSA and left common carotid artery (5 patients, 15.63%) or zone 1 landing with single fenestration for LSA and a chimney graft for left common carotid artery (1 patient, 3.13%). The technical success rate, defined as the successful alignment of fenestration to LSA, was 93.75%. At a mean follow-up of 17.3 months, 4 cases of endoleak and 2 cases of stent graft-induced new entry were noted, 3 of which were treated endovascularly.
Our preliminary results demonstrate the viability of preserving LSA blood flow in TEVAR using a handmade stent graft fenestration to treat various aortic pathologies in various clinical situations and the technical feasibility and short-term results that may justify the use of this method in emergency cases.
本研究旨在评估经胸主动脉支架移植物手工开窗治疗胸主动脉腔内修复术（TEVAR）中保留左锁骨下动脉（LSA）的疗效和安全性。
2015 年 7 月至 2018 年 10 月，共纳入 32 例因各种胸主动脉病变行 TEVAR 治疗的连续患者，术中使用经胸主动脉支架移植物手工开窗治疗 LSA。分析手术相关并发症、围手术期死亡率和发病率以及移植物通畅率等结果。
24 例（75.00%）患者为主动脉夹层，5 例（15.63%）为胸主动脉瘤，2 例（6.25%）为穿透性主动脉溃疡；1 例（3.13%）因前次 TEVAR 治疗胸腹主动脉瘤发生内漏和瘤腔扩张，需再次行 TEVAR。Zone 2 入路行 LSA 单开窗 26 例（81.25%），Zone 1 入路行 LSA 和左颈总动脉双开窗 5 例（15.63%），或 Zone 1 入路行 LSA 单开窗和左颈总动脉烟囱支架 1 例（3.13%）。以 fenestration 与 LSA 成功对齐为标准，技术成功率为 93.75%。平均随访 17.3 个月，发现 4 例内漏和 2 例支架移植物导致新入口，其中 3 例经血管内治疗。
我们的初步结果表明，在 TEVAR 中使用手工支架移植物开窗治疗各种主动脉病变，在各种临床情况下保留 LSA 血流是可行的，其技术可行性和短期结果可能证明在紧急情况下使用该方法是合理的。
