Lu Heng, Huang Ling-Chen, Chen Liang-Wan
Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian, China.
Front Cardiovasc Med. 2022 Jul 14;9:927592. doi: 10.3389/fcvm.2022.927592. eCollection 2022.
Aortic arch pathologies are serious clinical conditions associated with a very dismal prognosis. Traditional open surgery has a high mortality and is not suitable for critically ill patients. Recently years, endovascular treatment of thoracic aorta has made rapid progress and has been gradually applied to the treatment of aortic arch pathologies. However, maintaining cerebral blood flow during endovascular treatment of aortic arch lesions remains a challenge at this time. This study aims to evaluate the feasibility, efficacy, and safety of endovascular treatment of thoracic aortic pathologies involving the aortic arch, and to present initial experience with this technique.
From October 2016 to December 2020, patients who met the inclusion criteria were enrolled. All patients underwent thoracic endovascular aortic repair with the proximal landing zone of the stent-graft in the aortic arch at Ishimaru zones 0-1, in which cerebral flow needs to be maintained during surgery, and the supra-aortic branches were reconstruction with either fenestration or the chimney technique.
A total of 62 cases with lesions involving the arch were treated with endovascular surgery. Total supra-aortic branches reconstruction was successfully performed in 51 cases, the left carotid artery (LCA) and the innominate artery reconstruction were performed in eight cases, the left subclavian artery (LSA) and the LCA were reconstructed in three patients. Among them, the fenestration or chimney repair technique for the LSA was successful performed in 42 and 12 cases. However, in 20 patients, attempts to reconstruction the LSA using the fenestration technique were unsuccessful due to tortuous and angulated vessels. Early mortality was 6.45%. No neurological complications related to surgery occurred. Computer tomography images at post-operative follow-up (mean 3.51 months) confirmed patency of all branch stents without any signs of endoleaks, migration, conversion to retrograde dissection or receive open-heart surgery.
The endovascular technique is an effective, feasible, safe and repeatable method to reconstruct the aortic arch, which allows for the reconstruction of the supra-aortic branches.
主动脉弓病变是严重的临床病症，预后很差。传统的开放手术死亡率高，不适合重症患者。近年来，胸主动脉腔内治疗取得了快速进展，并已逐渐应用于主动脉弓病变的治疗。然而，目前在主动脉弓病变的腔内治疗过程中维持脑血流仍然是一项挑战。本研究旨在评估腔内治疗累及主动脉弓的胸主动脉病变的可行性、有效性和安全性，并展示该技术的初步经验。
2016年10月至2020年12月，纳入符合纳入标准的患者。所有患者均接受胸主动脉腔内修复术，支架移植物的近端锚定区位于石丸分区0-1的主动脉弓处，术中需要维持脑血流，采用开窗或烟囱技术重建主动脉弓上分支。
共有62例累及主动脉弓的病变患者接受了腔内手术治疗。51例成功完成了主动脉弓上分支的完全重建，8例完成了左颈动脉（LCA）和无名动脉重建，3例患者完成了左锁骨下动脉（LSA）和LCA重建。其中，LSA的开窗或烟囱修复技术分别成功实施了42例和12例。然而，20例患者因血管迂曲成角，采用开窗技术重建LSA未成功。早期死亡率为6.45%。未发生与手术相关的神经并发症。术后随访（平均3.51个月）的计算机断层扫描图像证实所有分支支架通畅，无任何内漏、移位、逆行夹层转化或接受心脏直视手术的迹象。
腔内技术是重建主动脉弓的一种有效、可行、安全且可重复的方法，能够重建主动脉弓上分支。
