Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
Ann Thorac Surg. 2019 Aug;108(2):491-498. doi: 10.1016/j.athoracsur.2019.02.026. Epub 2019 Mar 19.
This study evaluated the outcome of physician-modified thoracic stent grafts for the treatment of dissecting aortic arch aneurysms after surgical treatment of acute type A dissection.
From August 2016 through February 2018, 13 patients (8 men and 5 women) underwent thoracic endovascular aortic repair in which physician-modified thoracic stent grafts were used to treat dissecting aortic arch aneurysms after surgical treatment of acute type A dissection. Patients were a mean age of 70.7 ± 10 years (range, 43 to 82 years). Four patients were treated in an emergent setting for a symptomatic aortic arch aneurysm. The aneurysmal disease involved zone 0 in 10 patients and zone 2 in 3. Seven patients (48%) were treated using an aortic arch stent graft with a single fenestration, combined with cervical debranching in 4 patients. Six patients underwent total endovascular aortic arch repair using a double-fenestrated stent graft. Additional planned endovascular procedures were performed in 3 patients.
Median time for stent graft modifications was 18 minutes (range, 14 to 21 minutes). All the proximal entry tears in the arch were successfully excluded. The 30-day mortality rate was 0%. One patient (7.6%) had a stroke without permanent sequelae. The median length of stay was 5 days (range, 1 to 17 days). During follow up of 8 ± 6 months, there were no conversions to open repair, aortic rupture, paraplegia, or retrograde dissection.
The use of physician-modified thoracic stent grafts for the treatment of dissecting aortic arch aneurysm after surgical treatment of acute type A dissection is feasible and effective. Durability concerns will need to be assessed in future studies.
本研究评估了在急性 A 型夹层手术后，医生改良的胸主动脉支架移植物治疗夹层主动脉弓动脉瘤的结果。
2016 年 8 月至 2018 年 2 月，13 名患者（8 名男性，5 名女性）接受了胸主动脉腔内修复术，其中医生改良的胸主动脉支架移植物用于治疗急性 A 型夹层手术后的夹层主动脉弓动脉瘤。患者的平均年龄为 70.7 ± 10 岁（范围 43 至 82 岁）。4 例患者因症状性主动脉弓动脉瘤在紧急情况下接受治疗。动脉瘤病变累及 10 例患者的 0 区和 3 例患者的 2 区。7 例（48%）患者采用主动脉弓支架移植物加单一开窗，其中 4 例联合颈侧支去分支术。6 例患者采用双开窗支架移植物行全腔内主动脉弓修复术。3 例患者额外计划进行了腔内治疗。
支架移植物改良的中位时间为 18 分钟（范围 14 至 21 分钟）。所有弓部的近端入口撕裂均成功排除。30 天死亡率为 0%。1 例（7.6%）患者发生无永久性后遗症的脑卒中。中位住院时间为 5 天（范围 1 至 17 天）。在 8 ± 6 个月的随访中，无转为开放修复、主动脉破裂、截瘫或逆行夹层。
在急性 A 型夹层手术后，医生改良的胸主动脉支架移植物治疗夹层主动脉弓动脉瘤是可行且有效的。未来的研究需要评估其耐久性。
