Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China.
Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China.
J Thorac Cardiovasc Surg. 2021 Jul;162(1):12-22.e1. doi: 10.1016/j.jtcvs.2019.10.184. Epub 2019 Nov 23.
The preliminary clinical outcomes of a novel branch stent-grafting for endovascular repair of chronic aortic arch dissection proved its safety and effectiveness.
The purpose of this study is to present the long-term outcomes and evaluate the durability of this novel endovascular therapy.
Between August 2009 and January 2014, 51 patients with aortic dissections involving arch branches were treated by the endovascular stent-grafting. There were 7 Stanford type A aortic dissections, 22 retrograde type A aortic dissections, and 22 Stanford type B aortic dissections. The supra-arch branch arteries were reconstructed by individualized strategies.
All the proximal entry tears in arch were successfully excluded, and no type I/III endoleaks occurred. The median follow-up period was 92 months (range, 62-114 months). A total of 7 complications, 4 deaths, and 3 reinterventions occurred. There were 2 deaths from retrograde type A aortic dissections, 1 death from cerebral infarction, and 1 death from malignant tumor. The incidence of complications, reintervention, all-cause mortality, and aorta-related mortality was 0.035%/patient-year, 0.015%/patient-year, 0.020%/patient-year, and 0.010%/patient-year, respectively. The patency rate of cervical bypass was 90.1%. The significant true lumen recovery and false lumen shrinkage were observed at the 4 designated levels of the thoracic aorta according to computed tomography angiography images.
Based on preoperatively adequate planning and accurate measurement, endovascular repair of chronic aortic arch dissection using this branched stent-graft showed a low and an acceptable incidence of complications and mortality with positive aortic remodeling, which provided a satisfactory and promising alternative treatment option.
新型分支支架治疗慢性主动脉弓夹层的初步临床结果证明了其安全性和有效性。
本研究旨在介绍长期结果并评估这种新型血管内治疗的耐久性。
2009 年 8 月至 2014 年 1 月，51 例主动脉弓分支夹层患者接受了血管内支架治疗。其中 7 例为 Stanford A 型主动脉夹层，22 例为逆行性 Stanford A 型主动脉夹层，22 例为 Stanford B 型主动脉夹层。根据个体化策略重建超弓分支动脉。
所有弓上入口撕裂均成功排除，无 I/III 型内漏发生。中位随访时间为 92 个月（范围，62-114 个月）。共发生 7 例并发症，4 例死亡，3 例再次干预。2 例死亡原因为逆行性 Stanford A 型主动脉夹层，1 例死亡原因为脑梗死，1 例死亡原因为恶性肿瘤。并发症、再次干预、全因死亡率和主动脉相关死亡率的发生率分别为 0.035%/患者年、0.015%/患者年、0.020%/患者年和 0.010%/患者年。颈旁路通畅率为 90.1%。根据 CT 血管造影图像，在胸主动脉的 4 个指定水平观察到真腔明显恢复和假腔缩小。
基于术前充分的规划和准确的测量，使用这种分支支架治疗慢性主动脉弓夹层的血管内修复术具有较低且可接受的并发症和死亡率，主动脉重塑积极，为患者提供了一种令人满意且有前景的替代治疗选择。
