Division of Vascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Vasc Endovascular Surg. 2021 May;55(4):355-360. doi: 10.1177/1538574421989851. Epub 2021 Feb 4.
Adequate seal for thoracic endovascular aortic repair (TEVAR) commonly requires landing in zone 2, but can prove to be challenging due to the tortuous and angulated anatomy of the region.
Our objective was to determine the proximal landing accuracy of zone 2-targeted TEVARs following carotid-subclavian revascularization (CSR) and its impact on clinical outcomes.
Retrospective review of patients that underwent CSR for zone 2 endograft delivery at a tertiary institute between January 2008 and March 2018 was conducted. Technical outcomes were assessed by examining the incidence of intraoperative corrective maneuvers, 1a endoleaks and reinterventions. Distance to target and incidence of LSA stump filling were examined as radiographic markers of landing accuracy.
Zone 2-targeted TEVAR with CSR was performed in 53 patients for treatment of dissections (49%), aneurysms (30%) or trauma (21%). Nine (17%) cases required intraoperative corrective procedures: 5 (9%) proximal cuffs due to type 1a endoleak and 4 (8%) left common carotid artery (LCCA) stenting due to inadvertent coverage. Cases performed using higher resolution hybrid fluoroscopy machine compared to mobile C-arm were associated with increased proximal cuff use (OR 8.8; 95% CI 1.2-62.4). Average distance between the proximal edge of the covered graft to LCCA was 8 ± 1 mm and larger distances were not associated with higher rates of 1a endoleak. Twenty-eight (53%) cases of antegrade LSA stump filling were noted on follow-up imaging, but were not associated with higher rates of reinterventions (OR 0.8, 95% CI [0.2-4.6]). Three (6%) patients had a stroke within 30 days and 4 (8%) patients expired within 1 month. Intraoperative corrective maneuvers, post-operative 1a endoleak and reinterventions were not associated with higher rates of stroke or mortality.
Using current endografts and imaging modalities, zone 2-targeted TEVARs have suboptimal technical accuracy.
胸主动脉腔内修复术（TEVAR）需要足够的密封以覆盖区域 2，但由于该区域的曲折和角度解剖结构，这可能具有挑战性。
我们的目的是确定颈动脉-锁骨下血运重建（CSR）后区域 2 靶向 TEVAR 的近端着陆准确性及其对临床结果的影响。
回顾性分析了 2008 年 1 月至 2018 年 3 月在一家三级医院接受 CSR 以输送区域 2 内漏的患者。通过检查术中矫正操作、1a 内漏和再干预的发生率来评估技术结果。距离目标的距离和 LSA 残端填充的发生率被检查为着陆准确性的影像学标记。
53 例患者因夹层（49%）、动脉瘤（30%）或创伤（21%）接受了区域 2 靶向 TEVAR 治疗。9 例（17%）需要术中矫正：5 例（9%）因 1a 内漏而近端袖口，4 例（8%）因左颈总动脉（LCCA）支架覆盖而左颈总动脉（LCCA）支架覆盖。与移动 C 臂相比，使用更高分辨率的混合荧光透视机进行的病例与更频繁使用近端袖口相关（OR 8.8；95%CI 1.2-62.4）。覆盖移植物近端边缘与 LCCA 之间的平均距离为 8±1mm，较大的距离与更高的 1a 内漏发生率无关。28 例（53%）在随访成像上发现顺行 LSA 残端填充，但与更高的再干预率无关（OR 0.8，95%CI[0.2-4.6]）。3 例（6%）患者在 30 天内发生中风，4 例（8%）患者在 1 个月内死亡。术中矫正操作、术后 1a 内漏和再干预与更高的中风或死亡率无关。
使用当前的内漏和成像方式，区域 2 靶向 TEVAR 的技术准确性较差。
