Department of Thoracic and Cardio-Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
J Endovasc Ther. 2019 Oct;26(5):645-651. doi: 10.1177/1526602819858578. Epub 2019 Jun 26.
To evaluate outcomes of homemade fenestrated stent-grafts for complete endovascular aortic repair of aortic arch dissections. From July 2014 through September 2018, 35 patients (mean age 66±11 years; 25 men) underwent homemade fenestrated stent-graft repair of acute (n=16) or chronic (n=10) complicated type B aortic dissections (n=16) and dissecting aortic arch aneurysms subsequent to surgical treatment of acute type A dissections (n=9). Nineteen (54%) procedures were emergent. Zone 2 single-fenestrated stent-grafts were used in 25 cases; the remaining 10 were double-fenestrated stent-grafts deployed in zone 0. Median time for stent-graft modification was 18 minutes (range 16-20). Technical success was achieved in all cases. An immediate distal type I endoleak was treated intraoperatively. Among the double-fenestrated stent-graft cases, the left subclavian artery fenestration could not be cannulated in 2 patients and revascularization was required. Partial coverage of the left common carotid artery necessitated placement of a covered stent in 3 cases. One (3%) patient had a stroke without permanent sequelae. Two type II endoleaks required additional covered stent placement at 5 and 7 days postoperatively, respectively. The 30-day mortality was 6% (2 patients with ruptured aortic arch aneurysm). During a mean follow-up of 17.6±13 months, there was no aortic rupture or retrograde dissection. One late type I endoleak was treated with additional proximal fenestrated stent-graft placement. One type II endoleak is currently under observation. One additional patient died (unrelated to the aorta); overall mortality was 9%. All supra-aortic trunks were patent. The use of homemade fenestrated stent-grafts for endovascular repair of aortic arch dissections is feasible and effective for total endovascular aortic arch repair. Durability concerns will need to be assessed in additional studies with long-term follow-up.
评估自制开窗支架治疗主动脉弓夹层全腔内修复的结果。 2014 年 7 月至 2018 年 9 月，35 例患者（平均年龄 66±11 岁；25 例男性）接受了自制开窗支架治疗急性（n=16）或慢性（n=10）复杂型 B 型主动脉夹层（n=16）和急性 A 型夹层手术后的夹层主动脉弓动脉瘤（n=9）。19 例（54%）为急诊手术。25 例采用 Zone2 单开窗支架，其余 10 例采用 Zone0 双开窗支架。支架修改中位时间为 18 分钟（范围 16-20 分钟）。所有病例均达到技术成功。术中处理了即时的远端 I 型内漏。在双开窗支架病例中，2 例患者左锁骨下动脉开窗无法进行血管内治疗，需要进行血运重建。3 例患者左颈总动脉部分覆盖需要放置带膜支架。1 例（3%）患者发生无永久性后遗症的脑卒中。2 例 II 型内漏分别在术后 5 天和 7 天需要再次放置带膜支架。30 天死亡率为 6%（2 例患者为主动脉弓破裂）。平均随访 17.6±13 个月期间，无主动脉破裂或逆行夹层。1 例迟发性 I 型内漏行近端开窗支架加置。1 例 II 型内漏正在观察中。另外 1 例患者死亡（与主动脉无关）；总死亡率为 9%。所有主动脉弓上分支均通畅。 用自制开窗支架进行主动脉弓夹层的腔内修复是可行的，可有效进行全主动脉弓腔内修复。需要在具有长期随访的额外研究中评估耐久性问题。
