烟囱支架移植物用于胸主动脉腔内修复术中左锁骨下动脉的保护。
Chimney stent graft for left subclavian artery preservation during thoracic endograft placement.
机构信息
Vascular Group, The Institute for Vascular Health & Disease, Albany Medical College/Albany Medical Center Hospital, Albany, NY.
Vascular Group, The Institute for Vascular Health & Disease, Albany Medical College/Albany Medical Center Hospital, Albany, NY.
出版信息
J Vasc Surg. 2020 Mar;71(3):758-766. doi: 10.1016/j.jvs.2019.05.049.
OBJECTIVE
Carotid to subclavian artery bypass (CSB) has been the standard for revascularizing the left subclavian artery during coverage by thoracic endovascular aortic repair (TEVAR). The purpose of this study is to determine if a chimney stent graft (CSG) offers similar outcomes as an alternative to open bypass.
METHODS
A retrospective review of a single vascular surgery registry between February 2011 and September 2017 was performed of all left subclavian revascularization during elective TEVAR. Arch reconstructions involving more than just the left subclavian artery were excluded. Indications, demographics, procedural details, and outcomes were analyzed using standard statistical analysis.
RESULTS
Eighty-one patients with a mean age of 68 years (range, 32-87 years) had left subclavian revascularization (64 [79%] CSB vs 17 [21%] CSG) during TEVAR. Median follow-up for CSG was 8 months (range, 0-52 months) and for CSB was 14.5 months (range, 3-72). Demographics between the groups were similar except for more males in both groups (43 [67%] in CSB vs 10 [59%] in CSG; P = .28). The CSB group had significantly more aneurysms than dissections compared with CSG (45 [70%] vs 6 [35%]; P = .008). There were no perioperative occlusions or ischemic issues for either group in the perioperative period. Postoperative hematoma rates trended higher in the CSB (7.11% vs 1.6%; P = .53) with three (4.6%) of the CSB requiring evacuation of hematoma. Left hemispheric strokes were 6% in the CSB with none occurring in the CSG group. Perioperatively, the CSB group had one recurrent laryngeal nerve and one graft infection. Length of stay was similar in both groups (CSB, 8.4 days vs CSG, 9.1 days). Perioperative mortality was not statistically significant between both groups with two deaths (3%) in the CSB and none in the CSG group. No gutter leaks were identified on follow-up computed tomography scan during long-term follow-up. Patency rates were similar with only one occlusion in the CSB group at 23 months.
CONCLUSIONS
Left common carotid to subclavian artery bypass has been the standard for revascularization of the left subclavian artery during coverage by TEVAR. Chimney stent grafting to perfuse the left arm appears to offer equivalent results as a minimally invasive alternative.
目的
在胸主动脉腔内修复术（TEVAR）覆盖期间，颈动脉至锁骨下动脉旁路（CSB）一直是重建左锁骨下动脉的标准方法。本研究旨在确定烟囱支架移植物（CSG）是否可以作为一种替代开放旁路的方法，提供相似的结果。
方法
对 2011 年 2 月至 2017 年 9 月期间在选择性 TEVAR 期间进行的所有左锁骨下动脉血运重建的单一血管外科登记处进行回顾性分析。排除仅涉及左锁骨下动脉的弓部重建。使用标准统计分析方法分析适应证、人口统计学、手术细节和结果。
结果
81 例患者平均年龄为 68 岁（范围 32-87 岁），在 TEVAR 期间进行了左锁骨下动脉血运重建（64 例[79%]CSB 与 17 例[21%]CSG）。CSG 的中位随访时间为 8 个月（范围 0-52 个月），CSB 为 14.5 个月（范围 3-72 个月）。两组之间的人口统计学特征相似，但 CSB 组中男性更多（CSB 组 43 例[67%]与 CSG 组 10 例[59%]；P=0.28）。CSB 组的动脉瘤数量明显多于 CSG 组（45 例[70%]与 6 例[35%]；P=0.008）。两组在围手术期均无围手术期闭塞或缺血事件。CSB 组的术后血肿发生率较高（7.11%与 1.6%；P=0.53），其中 3 例（4.6%）CSB 需要清除血肿。CSB 组左侧半球中风发生率为 6%，CSG 组无中风发生。围手术期，CSB 组有 1 例喉返神经损伤和 1 例移植物感染。两组的住院时间相似（CSB 组 8.4 天与 CSG 组 9.1 天）。围手术期死亡率在两组之间无统计学意义，CSB 组有 2 例死亡（3%），CSG 组无死亡。在长期随访的 CT 扫描中没有发现沟漏。两组的通畅率相似，CSB 组只有 1 例在 23 个月时闭塞。
结论
在 TEVAR 覆盖期间，左颈总动脉至锁骨下动脉旁路一直是重建左锁骨下动脉的标准方法。烟囱支架移植以灌注左臂似乎提供了作为一种微创替代方法的等效结果。
Zotero 插件