Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria; Johannes Kepler University Linz, Medical Faculty, Linz, Austria.
J Thorac Cardiovasc Surg. 2022 Nov;164(5):1379-1389.e1. doi: 10.1016/j.jtcvs.2022.03.023. Epub 2022 Apr 6.
For thoracic endovascular aortic repair of the arch, branched and fenestrated endografts are available with different limitations regarding anatomy and extent of the pathology. Comparisons are lacking in the literature. The aim of this study was to compare the results of 2 currently commercially available devices for branched thoracic endovascular aortic repair and fenestrated thoracic endovascular aortic repair.
In a retrospective, multicenter cohort study, a consecutive patient series treated with branched thoracic endovascular aortic repair or fenestrated thoracic endovascular aortic repair for aortic arch pathologies was assessed. Baseline characteristics, procedural fenestrated thoracic endovascular aortic repair, and outcome were analyzed. Furthermore, the potential anatomic feasibility of the respective alternate device was assessed on the preoperative computed tomography scans.
The branched thoracic endovascular aortic repair and fenestrated thoracic endovascular aortic repair cohorts consisted of 20 and 34 patients, respectively, with similar comorbidities; indication was aneurysm in 65% and 79%, penetrating aortic ulcer in 20% and 9%, and dissection in the remaining procedures, respectively. Technical success was achieved in all but 1 patient. Perioperative mortality and major stroke rate were both 10% in branched thoracic endovascular aortic repair and 0% and 3% in fenestrated thoracic endovascular aortic repair, respectively. During follow-up of 31 and 40 months, 1 branch occlusion occurred in the branched thoracic endovascular aortic repair cohort, and 2 late endoleaks occurred in the fenestrated thoracic endovascular aortic repair group. One aortic death occurred. Although 35% of patients undergoing branched thoracic endovascular aortic repair were anatomically suitable for fenestrated thoracic endovascular aortic repair, 91% of those undergoing fenestrated thoracic endovascular aortic repair were suitable for branched thoracic endovascular aortic repair.
Both branched thoracic endovascular aortic repair and fenestrated thoracic endovascular aortic repair show excellent technical success and acceptable complication rates, whereas branched thoracic endovascular aortic repair tends toward higher morbidity, especially stroke rates. By offering fenestrated thoracic endovascular aortic repair along with branched thoracic endovascular aortic repair, aortic centers could potentially lower complication rates and simultaneously still treat a wide range of anatomies.
对于胸主动脉腔内修复术的弓部，分支型和开窗型血管内移植物在解剖结构和病变范围上存在不同的局限性。文献中缺乏比较。本研究的目的是比较两种目前市售的分支型胸主动脉腔内修复术和开窗型胸主动脉腔内修复术的结果。
在一项回顾性、多中心队列研究中，评估了连续接受分支型胸主动脉腔内修复术或开窗型胸主动脉腔内修复术治疗主动脉弓部病变的患者系列。分析了基线特征、手术过程、结局。此外，还在术前 CT 扫描上评估了各自备用器械的潜在解剖可行性。
分支型胸主动脉腔内修复术和开窗型胸主动脉腔内修复术队列分别包括 20 例和 34 例患者，合并症相似；65%和 79%的适应证为动脉瘤，20%和 9%的为穿透性主动脉溃疡，其余分别为夹层。除 1 例患者外，其余患者均获得技术成功。分支型胸主动脉腔内修复术的围手术期死亡率和主要卒中发生率分别为 10%和 0%和 3%。在 31 个月和 40 个月的随访中，分支型胸主动脉腔内修复术组发生 1 例分支闭塞，开窗型胸主动脉腔内修复术组发生 2 例晚期内漏。发生 1 例主动脉死亡。尽管 35%的接受分支型胸主动脉腔内修复术的患者在解剖上适合行开窗型胸主动脉腔内修复术，但 91%的接受开窗型胸主动脉腔内修复术的患者适合行分支型胸主动脉腔内修复术。
分支型胸主动脉腔内修复术和开窗型胸主动脉腔内修复术均显示出极好的技术成功率和可接受的并发症发生率，而分支型胸主动脉腔内修复术倾向于更高的发病率，特别是卒中发生率。通过提供开窗型胸主动脉腔内修复术和分支型胸主动脉腔内修复术，主动脉中心可以潜在地降低并发症发生率，同时仍能治疗广泛的解剖结构。
