Li Hai-Lei, Chan Yiu Che, Jia He-Yue, Cheng Stephan W
Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China.
Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China.
Ann Vasc Surg. 2022 Sep;85:371-382. doi: 10.1016/j.avsg.2022.03.020. Epub 2022 Mar 24.
To provide a contemporary review on endovascular false lumen (FL) embolization for thoracic aortic dissection (AD) and evaluate its early outcome.
A systematic literature review on FL embolization for thoracic AD from January 2003 to December 2020 was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Each article was analyzed using a standardized protocol including predefined demographic characteristics, perioperative mortality, and major complications.
A total of 29 papers with 229 patients were included into the analysis. The methods of FL occlusion used were the candy-plug technique, the knickerbocker technique, the "cork in the bottleneck" technique, and direct FL embolization with a combination of stent-grafts, coils, onyx, plugs, and glue. FL embolization procedure was performed in 79 patients (34.5%) with type A AD and 150 (65.5%) with type B AD. FL direct embolization was the most frequently used technique and it was applied in 198 (86.5%) patients. Candy-plug, knickerbocker, and "cork in the bottleneck" techniques were used in 26 (11.4%), 3 (1.3%), and 2 (0.9%) patients, respectively. Technical success was achieved in all patients except one (228/229, 99.6%) in which implantation of a stent to celiac trunk was not possible. There were 4 hospital deaths (1.7%). Neurological complications occurred in 6 patients (2.6%), including 4 (1.7%) spinal cord ischemia and 2 (0.9%) ischemic stroke. There were 1 (0.4%) iatrogenic retrograde dissection and 2 (0.9%) renal failure reported. The mean duration of follow-up was 16.5 months. There were 21 deaths (9.3%) during follow-up and 8 (3.6%) were aorta-related. Thirty three (14.7%) secondary interventions were performed. Five patients (2.2%) required an open completion thoracoabdominal procedure incorporating the stent-graft into the repair. Complete FL thrombosis was observed in 181 (80.4%) patients, 34 (15.1%) had partial thrombosis, and 10 (4.4%) had FL progression.
FL embolization of the distal thoracic aorta is a promising technique in a group of patients to promote FL thrombosis and aortic remodeling in thoracic aorta.
对胸主动脉夹层（AD）的血管内假腔（FL）栓塞进行当代综述，并评估其早期疗效。
按照系统评价与Meta分析的首选报告项目（PRISMA）声明的指导，对2003年1月至2020年12月期间胸主动脉夹层FL栓塞的文献进行系统回顾。每篇文章均使用标准化方案进行分析，包括预先定义的人口统计学特征、围手术期死亡率和主要并发症。
共纳入29篇论文，涉及229例患者进行分析。所采用的FL闭塞方法有糖果塞技术、灯笼裤技术、“瓶颈塞子”技术，以及使用支架移植物、线圈、Onyx、栓塞物和胶水联合进行的直接FL栓塞。79例（34.5%）A型AD患者和150例（65.5%）B型AD患者接受了FL栓塞手术。FL直接栓塞是最常用的技术，198例（86.5%）患者应用了该技术。糖果塞、灯笼裤和“瓶颈塞子”技术分别应用于26例（11.4%）、3例（1.3%）和2例（0.9%）患者。除1例（228/229，99.6%）无法向腹腔干植入支架外，所有患者均取得技术成功。有4例医院死亡（1.7%）。6例（2.6%）患者发生神经系统并发症，包括4例（1.7%）脊髓缺血和2例（0.9%）缺血性卒中。报告有1例（0.4%）医源性逆行夹层和2例（0.9%）肾衰竭。平均随访时间为16.5个月。随访期间有21例死亡（9.3%），其中8例（3.6%）与主动脉相关。进行了33例（14.7%）二次干预。5例（2.2%）患者需要进行开放性胸腹联合手术，将支架移植物纳入修复。181例（80.4%）患者观察到FL完全血栓形成，34例（15.1%）部分血栓形成，10例（4.4%）FL进展。
胸主动脉远端FL栓塞对于促进一组患者的FL血栓形成和胸主动脉重塑是一种有前景的技术。
