Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France.
German Aortic Center, Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany.
Ann Surg. 2021 May 1;273(5):997-1003. doi: 10.1097/SLA.0000000000003310.
The objective of this study was to evaluate the outcome of endovascular aortic arch repair for chronic dissection with a custom-made branched endograft.
Acute type A aortic dissections are often treated with prosthetic replacement of the ascending aorta. During follow-up, repair of an aneurysmal evolution of the false lumen distal to the ascending prosthesis can be a challenge both for the surgeon and the patient.
We conducted a multicenter, retrospective study of consecutive patients from 14 vascular units treated with a custom-made, inner-branched device (Cook Medical, Bloomington, IN) for chronic aortic arch dissection. Rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during follow-up were evaluated.
Seventy consecutive patients were treated between 2011 and 2018. All patients were considered unfit for conventional surgery. In-hospital combined mortality and stroke rate was 4% (n = 3), including 1 minor stroke, 1 major stroke causing death, and 1 death following multiorgan failure. Technical success rate was 94.3%. Twelve (17.1%) patients required early reinterventions: 8 for vascular access complication, 2 for endoleak correction, and 2 for pericardial effusion drainage. Median follow-up was 301 (138-642) days. During follow-up, 20 (29%) patients underwent secondary interventions: 9 endoleak corrections, 1 open repair for prosthetic kink, and 10 distal extensions of the graft to the thoracic or thoracoabdominal aorta. Eight patients (11%) died during follow-up because of nonaortic-related cause in 7 cases.
Endovascular treatment of aortic arch chronic dissections with a branched endograft is associated with low mortality and stroke rates but has a high reintervention rate. Further follow-up is required to confirm the benefits of this novel approach.
本研究旨在评估使用定制分支型移植物进行慢性主动脉弓夹层腔内修复的治疗效果。
急性A型主动脉夹层通常采用升主动脉假体置换治疗。在随访过程中，升主动脉假体远端假腔的瘤样扩张的修复对术者和患者来说都是一个挑战。
我们对 14 个血管单位的连续患者进行了一项多中心回顾性研究，这些患者使用定制的内分支装置（库克医疗，布卢明顿，印第安纳州）治疗慢性主动脉弓夹层。评估了院内死亡率和卒中率、技术成功率、早期和晚期并发症、再次干预和随访期间的死亡率。
2011 年至 2018 年期间，70 例连续患者接受了治疗。所有患者均被认为不适合传统手术。院内联合死亡率和卒中率为 4%（n=3），包括 1 例轻度卒中、1 例导致死亡的重度卒中和 1 例多器官衰竭死亡。技术成功率为 94.3%。12 例（17.1%）患者需要早期再次干预：8 例血管通路并发症，2 例内漏纠正，2 例心包积液引流。中位随访时间为 301（138-642）天。随访期间，20 例（29%）患者接受了二次干预：9 例内漏纠正，1 例因假体扭曲而行开放修复，10 例移植物向胸或胸腹主动脉的远端延长。8 例（11%）患者在随访期间因非主动脉相关原因死亡，其中 7 例为非主动脉相关原因。
使用分支型移植物治疗慢性主动脉弓夹层的腔内治疗与低死亡率和卒中率相关，但再次干预率较高。需要进一步随访以确认这种新方法的益处。
