Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
J Cardiothorac Surg. 2022 Mar 25;17(1):53. doi: 10.1186/s13019-022-01798-7.
Zone 2 thoracic endovascular aortic repair (TEVAR) is performed for the treatment of various thoracic aortic diseases involving the left subclavian artery. This study aimed to analyze the late clinical outcomes of zone 2 hybrid TEVAR according to the various indications.
A total of 48 patients who underwent zone 2 TEVAR at our institution between December, 2010 and July, 2020 were enrolled. The indications were aortic aneurysm (AA, n = 15), acute type B aortic dissection (AD, n = 14), penetrating aortic ulcer (PAU, n = 8), traumatic aortic injury (TAI, n = 8), and others (n = 3). The clinical outcomes including early complications and mid-term aortic measurements were retrospectively reviewed.
The technical success rate was 100% and in-hospital mortality occurred in one patient. The early postoperative complications included stroke (n = 1), transient spinal cord ischemia (n = 1), neck wound hematoma (n = 1), and left phrenic or vagus nerve injury (n = 9). In patients with AD, positive remodeling was observed in ten patients (76.9%) (false lumen regression in the entire or thoracic aorta [n = 9], false lumen thrombosis in the thoracic aorta [n = 1]). However, in patients with AA, increased aneurysm was found in six patients (40%). Persistent aneurysmal growth was found in patients with a maximal aortic diameter of > 60 mm on initial imaging (4/6, 50%). No aortic expansion was observed in those with TAI or PAU. Endoleak was noted in five patients (10.4%), and among them, aortic reintervention was required only in patients with large AAs.
Zone 2 hybrid TEVAR was associated with an acceptable early complication rate and provided acceptable mid-term aortic results for patients with AD, PAU, and TAI. However, patients with large AAs were at increased risk of aortic reintervention. In cases of large AA, clinicians should carefully consider whether zone 2 hybrid TEVAR or open surgical repair will be more effective for the patient.
2 区胸主动脉腔内修复术（TEVAR）用于治疗涉及左锁骨下动脉的各种胸主动脉疾病。本研究旨在根据不同的适应证分析 2 区杂交 TEVAR 的晚期临床结果。
2010 年 12 月至 2020 年 7 月，我院共收治 48 例 2 区 TEVAR 患者。适应证为主动脉瘤（AA，n=15）、急性 B 型主动脉夹层（AD，n=14）、穿透性主动脉溃疡（PAU，n=8）、创伤性主动脉损伤（TAI，n=8）和其他（n=3）。回顾性分析了临床结果，包括早期并发症和中期主动脉测量。
技术成功率为 100%，1 例患者住院死亡。术后早期并发症包括卒中（n=1）、短暂性脊髓缺血（n=1）、颈部伤口血肿（n=1）和左膈神经或迷走神经损伤（n=9）。AD 患者中，10 例（76.9%）出现正性重塑（整个或胸主动脉假腔缩小[n=9]，胸主动脉假腔血栓形成[n=1]）。然而，AA 患者中有 6 例（40%）发现动脉瘤增大。在初始影像学上最大主动脉直径>60mm 的患者中发现持续性动脉瘤生长（4/6，50%）。TAI 或 PAU 患者未见主动脉扩张。5 例（10.4%）患者发现内漏，其中仅在大型 AA 患者中需要主动脉再次介入治疗。
2 区杂交 TEVAR 早期并发症发生率可接受，为 AD、PAU 和 TAI 患者提供了可接受的中期主动脉结果。然而，大 AA 患者主动脉再次介入治疗的风险增加。对于大 AA，临床医生应仔细考虑 2 区杂交 TEVAR 或开放手术修复对患者更有效。
