Department of Vascular and Endovascular Surgery, Faculty of Medicine, Mansoura University, Egypt.
Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Vascular. 2023 Jun;31(3):447-454. doi: 10.1177/17085381211068230. Epub 2022 Jan 31.
The aim of this study is to summarize a single-center experience of hybrid debranching endovascular repair of the aortic arch and proximal descending thoracic aorta (DTA) with regard to the mid-term outcomes with highlighting the difference between the landing zones 0-2.
A retrospective review of data from a prospectively collected registry (Gangnam Severance Endovascular Aortic Registry) was performed. From among 332 patients whose aortic pathology was managed with TEVAR, 112 patients who underwent hybrid arch repair during the study period between 2012 and 2016 were identified. The patients were grouped into three cohorts according to the proximal landing zones (0, 1, and 2) of Ishimaru. The early outcome (30-days) in terms of mortality, morbidity, supra-aortic vessels patency, and presence of endoleak were analyzed. The survival, freedom from re-intervention, and major complications during follow-up were demonstrated.
During the study period. 112 patients (mean age 65±7, 79% males) were included. The patients were distributed in three cohorts: 8 (7%) patients with proximal landing zone 0, 20 (18%) with zone 1, and 80 (75%) with zone 2 hybrid aortic arch repair. Technical success was achieved in 7 (88%), 19 (90%), and 79 (94%) patients for zones 0, 1, and 2, respectively. The mean intensive care unit (ICU) stay was shorter in zone 2 ( = .005). The mean total hospital stay was shorter in zone 2 ( = .03). The overall in-hospital mortality rate was 5% (4/112). There was no spinal cord ischemia or early surgical conversion. Renal function deterioration was seen more but not significantly in zone 0 patients ( = .08). Respiratory failure was seen significantly in zone 0 patients ( = .01). Stroke occurred in 6/44 (14%) patients with degenerative aneurysm versus 1/60 (2%) patients with aortic dissection ( =.06). Early CTA showed 100% patency of the supra-aortic vessels. The early endoleak rate was significant in zone 0 patients ( = .008). The mean follow-up period was (32±19 months). The survival rates and freedom from re-intervention were not statistically significant among the three zones. However, the survival rate and freedom from intervention tend to be higher in zone 2 versus zone 0 ( = .07 and .09), respectively.
Hybrid debranching endovascular aortic arch repair is feasible and relatively safe with acceptable mid-term outcomes. Zone 0 patients has worse early and late outcomes in comparison to other zones. Careful patient selection and improved endovascular technology may be the key to improve the outcomes.
本研究旨在总结单中心杂交分支型腔内主动脉弓和近端降主动脉（DTA）修复的经验，重点介绍 Ishimaru 近端着陆区 0-2 之间的差异。
对前瞻性收集的登记处（江南分离血管腔内主动脉登记处）的数据进行回顾性分析。在 332 名接受 TEVAR 治疗的主动脉病变患者中，确定了 112 名在 2012 年至 2016 年期间接受杂交弓修复的患者。根据 Ishimaru 的近端着陆区（0、1 和 2）将患者分为三组。分析了早期（30 天）死亡率、发病率、主动脉以上血管通畅性和内漏的存在。显示了随访期间的生存、免于再次干预和主要并发症。
在研究期间，纳入了 112 名患者（平均年龄 65±7，79%为男性）。患者分布在三组中：近端着陆区 0 有 8 名（7%）患者，着陆区 1 有 20 名（18%）患者，着陆区 2 有 80 名（75%）患者。0、1 和 2 区的技术成功率分别为 88%、90%和 94%。2 区 ICU 停留时间较短（ =.005）。2 区总住院时间较短（ =.03）。总的院内死亡率为 5%（4/112）。无脊髓缺血或早期手术转换。肾功能恶化在 0 区患者中更为常见，但无统计学意义（ =.08）。0 区患者呼吸衰竭发生率显著（ =.01）。退行性动脉瘤患者中有 6/44（14%）发生中风，而主动脉夹层患者中有 1/60（2%）发生中风（ =.06）。早期 CTA 显示主动脉以上血管通畅率为 100%。0 区患者早期内漏发生率显著（ =.008）。平均随访时间（32±19 个月）。三组之间的生存率和免于再次干预的情况无统计学意义。然而，2 区的生存率和免于干预的比例均高于 0 区（ =.07 和.09）。
杂交分支型腔内主动脉弓修复是可行的，且具有相对安全的中期结果。与其他区域相比，0 区患者的早期和晚期结果较差。仔细的患者选择和改进的腔内技术可能是改善结果的关键。
