Davaine Jean-Michel, Jayet Jérémie, Oiknine Léa, Martin Garance, Couture Thibault, Verscheure Dorian, Koskas Fabien
Sorbonne Université, Faculté de Médecine Campus Pitié-Salpêtrière, Paris, France.
Vascular Surgery Department, University Hospital Pitié-Salpêtrière, Paris, France.
EJVES Vasc Forum. 2022 Feb 4;55:16-22. doi: 10.1016/j.ejvsvf.2022.01.015. eCollection 2022.
The treatment of complex aortic disease has been described with various retrograde visceral bypass techniques. An original technique with a single stem retrograde visceral graft (SSRVG) is presented.
This was a single centre retrospective study including 16 patients between 2015 and 2019. Patients were treated for aortic dissection (AD; type A and acute or chronic type B), thoraco-abdominal aortic aneurysms (TAAAs), and visceral occlusive disease. Surgery consisted of visceral vessel debranching from the native infrarenal aorta or from an aortic graft. In the case of AD, surgical fenestration was performed. Additional thoracic endovascular aneurysm repair (TEVAR) completed the treatment when indicated, during the same procedure or later. Patient outcomes and reconstruction patency were studied.
The mean patient age was 64 years (median 68 ± 12.6). Ten (62%) patients were treated for AD, three (19%) for TAAA, and three (19%) for occlusive disease. Sixty-nine target vessels were debranched with this SSRVG technique. Aortic surgical fenestration was performed in eight cases and TEVAR in four. During their hospital stay, three (19%) TAAA patients died, seven cases of renal insufficiency (44%), four cases of pneumonia (25%), and three colonic ischaemia cases (19%) were noted. After a mean follow up of 21 months, no other deaths occurred. All vessels (except two inferior mesenteric arteries) were patent and no endoleak was noted.
The SSRVG technique can be offered in various complex aortic diseases. The use of a single graft is feasible and reduces the volume of multiple branch assembly in the retroperitoneal space. The observed patency rate is high.
已采用多种逆行内脏旁路技术来描述复杂主动脉疾病的治疗。本文介绍了一种采用单干逆行内脏移植物（SSRVG）的原创技术。
这是一项单中心回顾性研究，纳入了2015年至2019年间的16例患者。患者接受了主动脉夹层（AD；A型以及急性或慢性B型）、胸腹主动脉瘤（TAAA）和内脏闭塞性疾病的治疗。手术包括将内脏血管从肾下腹主动脉或主动脉移植物上离断。对于AD患者，进行了手术开窗。如有必要，在同一手术过程中或之后进行额外的胸主动脉腔内修复术（TEVAR）以完成治疗。研究了患者的预后和重建通畅情况。
患者的平均年龄为64岁（中位数为68±12.6）。10例（62%）患者接受了AD治疗，3例（19%）接受了TAAA治疗，3例（19%）接受了闭塞性疾病治疗。采用该SSRVG技术离断了69支目标血管。8例患者进行了主动脉手术开窗，4例进行了TEVAR。在住院期间，3例（19%）TAAA患者死亡，7例出现肾功能不全（44%），4例发生肺炎（25%），3例出现结肠缺血（19%）。平均随访21个月后，未发生其他死亡病例。所有血管（除两支肠系膜下动脉外）均保持通畅，未发现内漏。
SSRVG技术可用于多种复杂主动脉疾病。使用单一移植物是可行的，且减少了腹膜后间隙中多分支组件的体积。观察到的通畅率较高。
