Sun Guoyi, Ge Yang-Yang, Guo Wei, Jia Xin, Rong Dan, Liu Xiao-Ping, Xiong Jiang, Zhang Hong-Peng, Ma Xiao-Hui
Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
Vasc Endovascular Surg. 2020 May;54(4):333-340. doi: 10.1177/1538574420912356.
This study was performed to investigate the long-term effect of chimney technique using balloon-expandable bare-metal stents (BMSs) to preserve the supra-arch branches in type B aortic dissection (TBAD).
Fifty patients with TBAD treated by thoracic endovascular aortic repair with the chimney technique (chTEVAR) using balloon-expandable BMSs from July 2009 to December 2013 were retrospectively assessed. Follow-up computed tomography angiography was performed to assess the postoperative outcomes. The primary end point was a persistent type Ia endoleak (ELIa). The secondary endpoints were chimney stent (CS)-based complications (stenosis, occlusion, fracture, or transposition), all-cause mortality, reintervention, and stroke.
Fifty supra-arch branches (left common carotid artery, n = 11; left subclavian artery, n = 39) were preserved via the chimney technique with 50 balloon-expandable BMSs. The technical success rate was 100%. An immediate ELIa was discovered in 9 (18%) patients. The median survival duration during follow-up was 77.3 months. Five (10%) patients had a persistent ELIa; 3 of these patients had an immediate ELIa. Asymptomatic CS-based complications were found in 3 (6%) patients. The all-cause mortality rate was 8% (4/50); 2 deaths were aortic-related deaths. Five (10%) patients underwent a reintervention. During the estimated 36-month survival period, the survival rate, the rate of freedom from persistent ELIa, and the rate of freedom from reintervention were 93.87%, 89.48%, and 95.56%, respectively.
The long-term outcomes showed that chTEVAR using balloon-expandable BMSs was safe and feasible for preservation of the supra-arch branches. Evaluation of more patients with a longer follow-up period is needed.
本研究旨在探讨使用球囊扩张式裸金属支架（BMS）的烟囱技术在B型主动脉夹层（TBAD）中保留弓上分支的长期效果。
回顾性评估2009年7月至2013年12月期间50例采用球囊扩张式BMS的烟囱技术（chTEVAR）进行胸主动脉腔内修复术治疗的TBAD患者。通过随访计算机断层扫描血管造影术评估术后结果。主要终点是持续性Ia型内漏（ELIa）。次要终点是基于烟囱支架（CS）的并发症（狭窄、闭塞、断裂或移位）、全因死亡率、再次干预和中风。
通过烟囱技术使用50个球囊扩张式BMS保留了50个弓上分支（左颈总动脉，n = 11；左锁骨下动脉，n = 39）。技术成功率为100%。9例（18%）患者发现即刻ELIa。随访期间的中位生存时间为77.3个月。5例（10%）患者存在持续性ELIa；其中3例患者有即刻ELIa。3例（6%）患者发现无症状的基于CS的并发症。全因死亡率为8%（4/50）；2例死亡为主动脉相关死亡。5例（10%）患者接受了再次干预。在估计的36个月生存期内，生存率、无持续性ELIa率和无再次干预率分别为93.87%、89.48%和95.56%。
长期结果表明，使用球囊扩张式BMS的chTEVAR在保留弓上分支方面是安全可行的。需要对更多患者进行更长随访期的评估。
