Division of Vascular Surgery, Department of Surgery, the Jikei University School of Medicine, Tokyo, Japan.
Division of Vacular Surgery, International University of Health and Welfare, Narita, Japan.
J Vasc Surg. 2022 Mar;75(3):803-811.e2. doi: 10.1016/j.jvs.2021.10.031. Epub 2021 Nov 4.
To evaluate the early outcomes of retrograde in situ branched stent grafting (RIBS) using the gutter balloon technique for complex aortic arch aneurysms (CAAs).
The RIBS technique is an in situ needle fenestration procedure during thoracic endovascular aortic repair with the reconstruction of cervical branches. The double RIBS (D-RIBS) for the reconstruction of the left common carotid artery and the brachiocephalic artery using the gutter balloon technique was performed in 30 high-risk patients. We describe the early clinical results of the D-RIBS technique for CAAs. Primary end points were technical success and 30-day mortality. Secondary end points were postoperative complications, rates of endoleaks, overall survival, aneurysm-related death, and reinterventions.
The mean age was 77.1 ± 6.6 years, and the mean maximum minor-axis aneurysmal diameter was 65.9 ± 8.9 mm. Twenty-six patients underwent D-RIBS for elective arch aortic aneurysm, and four patients were for reintervention after zone 2 thoracic endovascular aortic repair failure. Stent graft puncture was performed 60 times from the common carotid arteries, and technical success was achieved in all cases (100%). Postoperative complications included cerebral infarction in two patients (6.7%) and recurrent nerve palsy in one patient (3.3%). The 30-day mortality was 0%. During the median follow-up period of 14 months (6-56 months), overall survival at 12 months was 92.3% without any aneurysm-related death. Type 1 b and type 2 endoleaks were observed in one each, and no reintervention was encountered.
Early clinical outcomes of the D-RIBS for high-risk patients with CAAs are acceptable. The gutter balloon method enables safe and reliable fenestration. Further studies and dedicated devices are warranted.
评估使用 gutter 球囊技术行逆行原位分支支架移植物（RIBS）治疗复杂主动脉弓动脉瘤（CAA）的早期结果。
RIBS 技术是一种在胸主动脉腔内修复术中进行原位针孔开窗的方法，同时重建颈部分支。我们对 30 例高危 CAA 患者采用 gutter 球囊技术行双 RIBS（D-RIBS）治疗，重建左颈总动脉和头臂干。我们描述了 D-RIBS 治疗 CAA 的早期临床结果。主要终点为技术成功和 30 天死亡率。次要终点为术后并发症、内漏发生率、总生存率、与动脉瘤相关的死亡率和再次干预。
平均年龄为 77.1±6.6 岁，最大短轴动脉瘤直径平均为 65.9±8.9mm。26 例患者因择期主动脉弓动脉瘤行 D-RIBS，4 例患者因 zone 2 胸主动脉腔内修复失败而再次干预。从颈总动脉共穿刺支架移植物 60 次，所有病例均获得技术成功（100%）。术后并发症包括 2 例（6.7%）脑梗死和 1 例（3.3%）膈神经麻痹。30 天死亡率为 0%。在 14 个月（6-56 个月）的中位随访期间，12 个月总生存率为 92.3%，无动脉瘤相关死亡。1 例出现 1 型 b 型和 2 型内漏，无再次干预。
高危 CAA 患者行 D-RIBS 的早期临床结果可接受。 gutter 球囊方法可实现安全可靠的开窗。需要进一步研究和专用器械。
