Gao Wentao, Yang Guangmin, Zhu Yuelin, Wang Wei, Liu Zhao, Zhang Ming, Zhou Min, Li Xiaoqiang
Department of Vascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
Department of Vascular Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, People's Republic of China.
Ann Vasc Surg. 2022 Apr;81:105-112. doi: 10.1016/j.avsg.2021.09.026. Epub 2021 Nov 12.
The aim of this study was to analyze the short-term outcomes of in situ fenestration and discuss its feasibility and safety for the treatment of aortic dissection or aneurysm involving aortic arch.
A retrospective single-center review was conducted on patients who were treated with ISF technique to revascularize supra-arch branches from Jun 2017 to Oct 2019. Computed tomographic angiography was performed to assess the patency of bridging stents, endoleaks and prognosis prior to discharge, after 3 months, 6 months, 12 months and yearly thereafter. Patient demographics, operative details, clinical outcomes, and complications were analyzed and then discussed in this paper.
A total of 21 patients were diagnosed with arch pathologies, 5 type A aortic dissections, 12 type B aortic dissections and 4 thoracic aortic aneurysms. There were 19 men and 2 women (mean age 60.7 ± 15.3). 8 cases were treated with three-fenestration stent grafts, 1 case with two-fenestration stent graft, and 12 cases with single-fenestration stent grafts. Overall technical success rate was 95.2%. Mean operation time was 227.4 ± 143.8 minutes. Complications were intraoperative hemorrhage (>1000 ml, 2), stroke (2), hydropericardium (1) and endoleaks (2 type Ⅲ, 1 type Ⅰ). There was no aorta-related mortality or late endoleaks during the mean follow-up of 25.5 ± 6.2 months. All the bridging stents remained patent and there was no migration according to follow-up Computed tomographic angiography.
With low complication and mortality rate, ISF is an effective and feasible method for the total endovascular aortic arch repair. Long-term follow-up study is needed to evaluate its durability.
本研究旨在分析原位开窗术的短期疗效，并探讨其治疗累及主动脉弓的主动脉夹层或动脉瘤的可行性和安全性。
对2017年6月至2019年10月期间采用原位开窗术（ISF）技术重建弓上分支血运的患者进行单中心回顾性研究。在出院前、3个月、6个月、12个月及此后每年进行计算机断层血管造影，以评估桥接支架的通畅情况、内漏及预后。分析患者的人口统计学资料、手术细节、临床结局和并发症，并在本文中进行讨论。
共有21例患者被诊断为弓部病变，其中5例为A型主动脉夹层，12例为B型主动脉夹层，4例为胸主动脉瘤。男性19例，女性2例（平均年龄60.7±15.3岁）。8例采用三分窗支架型人工血管治疗，1例采用二分窗支架型人工血管治疗，12例采用单分窗支架型人工血管治疗。总体技术成功率为95.2%。平均手术时间为227.4±143.8分钟。并发症包括术中出血（>1000 ml，2例）、卒中（2例）、心包积液（1例）和内漏（Ⅲ型2例，Ⅰ型1例）。在平均25.5±6.2个月的随访期间，无主动脉相关死亡或晚期内漏。根据随访计算机断层血管造影，所有桥接支架均保持通畅，无移位。
原位开窗术并发症和死亡率低，是全腔内主动脉弓修复的一种有效且可行的方法。需要进行长期随访研究以评估其耐久性。
