Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, 650 New Song Jiang Road, Shanghai, 201600, People's Republic of China.
Cardiovasc Intervent Radiol. 2022 Jun;45(6):733-743. doi: 10.1007/s00270-022-03063-9. Epub 2022 Mar 30.
We compared the mid-term outcomes of a one-piece branched stent-graft with the chimney technique in the treatment of aortic arch pathologies.
Between August 2012 and December 2017, a retrospective analysis of 279 patients with thoracic aortic dissection (TAD) or aneurysm (TAA) who underwent thoracic endovascular aortic repair with b-TEVAR (n = 69, 58 TAD and 11 TAA) or c-TEVAR (n = 210, 151 TAD and 59 TAA) was performed.
Forty-five double-chimney for the left subclavian artery (LSA) and left common carotid artery LCCA and 165 single-chimney for the LSA were performed in chimney-TEVAR (c-TEVAR) and 69 branched-TEVAR (b-TEVAR) with 36 single-branched stent-grafts and 33 branched stent-grafts combined with fenestration technique. The c-TEVAR group experienced more in-hospital complications than the b-TEVAR group (19.5 vs. 7.2%, p = 0.017), primarily because the c-TEVAR group experienced more in-hospital cerebral ischemia events (6.2 vs. 0%, p = 0.043) and intra-operative type I endoleaks (31.9 vs. 5.8%, p < 0.01). There were significantly more follow-up type I endoleaks (21.9 vs. 4.3%, p = 0.002), cerebral ischemia events (11.0 vs. 2.9%, p = 0.042), and re-interventions (12.9 vs. 4.3%, p = 0.048) in the c-TEVAR group than in the b-TEVAR group. However, follow-up mortality was not significantly different between the c-TEVAR and b-TEVAR groups (5.2 vs. 2.9%, p = 0.638).
In patients with aortic pathologies involving the arch branches, customized b-TEVAR may result in fewer cerebral ischemia events and endoleaks than c-TEVAR. However, c-TEVAR should be considered an off-the-shelf treatment option for patients in need of emergency treatment.
Level 4, Case Series.
比较一体式分支支架移植物与烟囱技术在主动脉弓病变治疗中的中期结果。
2012 年 8 月至 2017 年 12 月，对 279 例接受胸主动脉腔内修复术（b-TEVAR，n=69，58 例胸主动脉夹层和 11 例胸主动脉瘤）或胸主动脉腔内修复术（c-TEVAR，n=210，151 例胸主动脉夹层和 59 例胸主动脉瘤）的胸主动脉夹层（TAD）或动脉瘤（TAA）患者进行回顾性分析。
在烟囱-TEVAR（c-TEVAR）和分支-TEVAR（b-TEVAR）中，分别进行了 45 例左锁骨下动脉（LSA）和左颈总动脉 LCCA 的双烟囱和 165 例 LSA 的单烟囱，采用 36 个单分支支架移植物和 33 个分支支架移植物联合开窗技术。c-TEVAR 组的院内并发症发生率高于 b-TEVAR 组（19.5%比 7.2%，p=0.017），主要是因为 c-TEVAR 组发生了更多的院内脑缺血事件（6.2%比 0%，p=0.043）和术中 I 型内漏（31.9%比 5.8%，p<0.01）。c-TEVAR 组的随访 I 型内漏（21.9%比 4.3%，p=0.002）、脑缺血事件（11.0%比 2.9%，p=0.042）和再次介入治疗（12.9%比 4.3%，p=0.048）发生率明显高于 b-TEVAR 组。然而，c-TEVAR 组和 b-TEVAR 组的随访死亡率无显著差异（5.2%比 2.9%，p=0.638）。
对于累及主动脉弓分支的主动脉病变患者，定制的 b-TEVAR 可能比 c-TEVAR 导致更少的脑缺血事件和内漏。然而，c-TEVAR 应被视为需要紧急治疗的患者的一种现成治疗选择。
4 级，病例系列。
