Bi Jiaxue, Niu Fang, Li Peng, Dai Xiangchen, Zhu Jiechang, Liu Zongwei
Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China.
Vascular. 2022 Jun;30(3):432-440. doi: 10.1177/17085381211019611. Epub 2021 Jun 8.
To summarize the experience and midterm outcomes of physician-modified endovascular grafts for zone 2 thoracic endovascular aortic repair.
A retrospective analysis was conducted of 51 consecutive patients (mean age 57.6 ± 12.5 years, 39 males) treated with thoracic endovascular aortic repair using physician-modified endovascular grafts for reconstructing the left subclavian artery from November 2015 to December 2019. The primary endpoints during follow-up were the overall mortality, aorta-related mortality, and major complications. The secondary endpoints were reintervention and the patency of the target branches, the demographics and technical details were also described and analyzed.
Sixty-three thoracic stent-grafts were deployed in 51 patients and emergency surgery was performed in 10 patients (19.6%). Technical success was 94.1% (48/51). The incidence of perioperative complications was 15.7%, and the 30-day mortality was 0%. At a mean follow-up of 42.0 ± 14.4 months (range, 14-63 months), all the left subclavian arteries remained patent. All-cause mortality was 3.9% (2/51) and not aorta-related deaths. Estimated survival at one and three years was 98.0 ± 1.9% and 96.0 ± 2.8%, respectively.
The physician-modified endovascular grafts is feasible and effective to preserve left subclavian artery in thoracic endovascular aortic repair for aortic arch pathologies with unhealthy proximal landing zone.
总结医师改良型血管内移植物用于2区胸段血管腔内主动脉修复术的经验及中期结果。
对2015年11月至2019年12月期间连续51例（平均年龄57.6±12.5岁，男性39例）采用医师改良型血管内移植物行胸段血管腔内主动脉修复术以重建左锁骨下动脉的患者进行回顾性分析。随访期间的主要终点为总死亡率、主动脉相关死亡率和主要并发症。次要终点为再次干预和目标分支的通畅情况，还对人口统计学和技术细节进行了描述和分析。
51例患者共植入63枚胸段支架型人工血管，10例患者（19.6%）接受了急诊手术。技术成功率为94.1%（48/51）。围手术期并发症发生率为15.7%，30天死亡率为0%。平均随访42.0±14.4个月（范围14 - 63个月），所有左锁骨下动脉均保持通畅。全因死亡率为3.9%（2/51），且与主动脉无关。1年和3年的估计生存率分别为98.0±1.9%和96.0±2.8%。
对于近端锚定区不健康的主动脉弓病变，医师改良型血管内移植物在胸段血管腔内主动脉修复术中保留左锁骨下动脉是可行且有效的。
