Kreibich Maximilian, Siepe Matthias, Berger Tim, Kondov Stoyan, Morlock Julia, Pingpoh Clarence, Beyersdorf Friedhelm, Rylski Bartosz, Czerny Martin
Department of Cardiovascular Surgery, University Heart Centre Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Department of Cardiovascular Surgery, University Heart Centre Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Eur J Vasc Endovasc Surg. 2021 Jan;61(1):107-113. doi: 10.1016/j.ejvs.2020.08.040. Epub 2020 Sep 29.
To evaluate outcomes of patients with acute complicated or chronic Type B or non-A non-B aortic dissection who underwent the frozen elephant trunk (FET) technique.
Between April 2013 and July 2019, 41 patients presenting with acute complicated (n = 29) or chronic (n = 12) descending thoracic aortic dissection were treated by the FET technique, which was the treatment of choice when supra-aortic vessel transposition would not suffice to create a satisfactory proximal landing zone for endovascular aortic repair, when a concomitant ascending or arch aneurysm was present, or in patients with connective tissue diseases.
One patient (2%) died intra-operatively secondary to an aortic rupture in dwnstream aortic segments. No post-operative deaths occurred. Four patients (10%) suffered a non-disabling posto-operative stroke and were discharged with no clinical symptoms (modified Rankin Scale [mRS] 0, n = 1), no significant disability (mRS 1, n = 2), or with slight disability (mRS 2, n = 1). No spinal cord ischaemia was observed. The primary entry tear was either surgically resected or excluded from circulation in all patients. During follow up, one patient (2%) died after two years (not aorta related) and 16 patients (39%) underwent an aortic re-intervention after 7.7 [interquartile range 0.7, 15.8] months (endovascular aortic repair: n = 14; open thoraco-abdominal aortic replacement: n = 1, hybrid approach: n = 1).
The FET technique is an effective treatment option for acute complicated and chronic Type B or non-A non-B aortic dissection in patients in whom primary endovascular aortic repair is non-feasible. While the post-operative outcome is acceptable with a relatively low incidence of non-disabling strokes, this study also underlines the considerable need for aortic re-interventions. Continuous follow up of all patients undergoing the FET procedure is essential.
评估接受冰冻象鼻（FET）技术治疗的急性复杂性或慢性B型或非A非B型主动脉夹层患者的治疗结果。
2013年4月至2019年7月期间，41例表现为急性复杂性（n = 29）或慢性（n = 12）降主动脉夹层的患者接受了FET技术治疗，当主动脉弓上血管转位不足以创建一个令人满意的近端锚定区用于血管腔内主动脉修复、存在升主动脉或主动脉弓动脉瘤时，或结缔组织疾病患者时，该技术为首选治疗方法。
1例患者（2%）术中因下游主动脉段主动脉破裂死亡。无术后死亡病例。4例患者（10%）发生非致残性术后卒中，出院时无临床症状（改良Rankin量表[mRS] 0，n = 1）、无明显残疾（mRS 1，n = 2）或轻度残疾（mRS 2，n = 1）。未观察到脊髓缺血。所有患者的原发破口均通过手术切除或使其脱离循环。随访期间，1例患者（2%）在两年后死亡（与主动脉无关），16例患者（39%）在7.7 [四分位间距0.7，15.8]个月后接受了主动脉再次干预（血管腔内主动脉修复：n = 14；胸腹主动脉开放置换：n = 1；杂交手术：n = 1）。
对于无法进行原发性血管腔内主动脉修复的急性复杂性和慢性B型或非A非B型主动脉夹层患者，FET技术是一种有效的治疗选择。虽然术后结果可以接受，非致残性卒中发生率相对较低，但本研究也强调了主动脉再次干预的迫切需求。对所有接受FET手术的患者进行持续随访至关重要。
