State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Xicheng District, Beijing, China.
Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, Yunnan, China.
J Endovasc Ther. 2021 Feb;28(1):36-43. doi: 10.1177/1526602820953406. Epub 2020 Sep 1.
To evaluate the safety and feasibility of the in situ needle fenestration (ISNF) technique for reconstruction of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) of complicated aortic arch pathologies.
A retrospective review was conducted from January 2014 to December 2019 of 50 patients (mean age 60.2±11.1; 45 men) who underwent ISNF to revascularize the LSA during TEVAR. Twenty-one of the patients also required revascularization of the left common carotid artery (LCCA; n=19) and innominate artery (IA; n=2) using physician-modified in vitro fenestration. Overall, 73 supra-aortic branches were targeted for revascularization.
ISNF was successful in 48 patients (96%); one LSA could not be stented and a tortuous LSA prevented the needle from fenestrating the graft. No perioperative major adverse event occurred. There were no type I and 4 type III endoleaks (8%), 3 of which occurred among the first 20 cases. Types II and IV endoleaks were found in 3 (6%) and 6 (12%) cases, respectively; all disappeared during a median follow-up of 15 months (range 3-66). One death (2%) occurred within 12 months due to cerebral hemorrhage. Two patients (4%) required open reinterventions at 6 and 62 months.
ISNF for revascularization of the LSA during TEVAR seems to be feasible with acceptable midterm outcomes. The learning curve and evolving patient selection criteria affected technical success, complications, and the need for reinterventions. Long-term durability requires further evaluation.
评估原位针开窗（ISNF）技术在胸主动脉腔内修复（TEVAR）治疗复杂主动脉弓病变时重建左锁骨下动脉（LSA）的安全性和可行性。
回顾性分析 2014 年 1 月至 2019 年 12 月期间 50 例（平均年龄 60.2±11.1；45 例男性）接受 ISNF 以重建 LSA 血运的患者资料。其中 21 例患者还需要采用改良体外开窗技术重建左颈总动脉（LCCA；n=19）和无名动脉（IA；n=2）。总共需要对 73 个升主动脉分支进行血运重建。
48 例（96%）患者的 ISNF 成功，1 例 LSA 无法置入支架，LSA 迂曲导致无法穿刺开窗。无围手术期重大不良事件发生。无 I 型和 4 型内漏（8%），其中 3 例发生在最初 20 例患者中。II 型和 IV 型内漏分别为 3 例（6%）和 6 例（12%），在中位随访 15 个月（3-66 个月）期间均消失。1 例患者（2%）在 12 个月内死于脑出血。2 例患者（4%）分别在 6 个月和 62 个月时需要进行开放再介入治疗。
TEVAR 时进行 ISNF 重建 LSA 似乎是可行的，具有可接受的中期结果。学习曲线和不断变化的患者选择标准影响了技术成功率、并发症和再介入治疗的需求。长期耐久性需要进一步评估。
