Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79# Qingchun Road, Hangzhou, 310003, Zhejiang, China.
Cardiovasc Intervent Radiol. 2022 Nov;45(11):1672-1681. doi: 10.1007/s00270-022-03232-w. Epub 2022 Aug 10.
To report the early experience and mid-term outcomes of physician-modified fenestrated or branched endovascular repair (PM-F/BEVAR) for patients with post-dissection thoracoabdominal aortic aneurysm (PD-TAAA).
PD-TAAA patients treated with PM-F/BEVAR between December 2014 and September 2020 in our institution were retrospectively analyzed.
Out of the 39 patients, technical success defined as successful deployment of all stent grafts with patent target vessels (TVs) and exclusion of the lesion without type I or III endoleak was achieved in 35 patients (89.7%). A total of 126 TVs were successfully reconstructed. Thirty-day mortality was 0%. Seven major adverse events occurred including one acute kidney injury, four renal infarctions, one retroperitoneal hematoma and one left renal artery occlusion. Seven type II endoleak and three type III endoleak were detected. During a mean 29.4 ± 15.5 months follow-up period, the mortality was zero. Three renal arteries and one external iliac artery occluded in four patients. No other new onset major adverse event occurred. No patient required reintervention. One type II endoleak spontaneously resolved, while the remaining six remained stable. One early type III endoleak diminished, and one new type III endoleak occurred at 2 months. The primary patency of TV was 96.8% (120/124). Shrinkage or stability of aneurysm diameter can be observed in 38 patients (97.4%). The false lumen thrombosis rate was 89.7% (35/39).
The present study showed encouraging results of PM-F/BEVAR for treatment of PD-TAAAs.
Level 4, Case Series.
报告医生改良的开窗或分支腔内修复术（PM-F/BEVAR）治疗夹层后胸腹主动脉瘤（PD-TAAA）患者的早期经验和中期结果。
回顾性分析 2014 年 12 月至 2020 年 9 月期间在我院接受 PM-F/BEVAR 治疗的 PD-TAAA 患者。
39 例患者中，35 例（89.7%）达到技术成功，定义为所有支架移植物成功植入，目标血管（TV）通畅，病变无 I 型或 III 型内漏。共成功重建 126 个 TV。30 天死亡率为 0%。发生 7 例重大不良事件，包括急性肾损伤 1 例、肾梗死 4 例、腹膜后血肿 1 例、左肾动脉闭塞 1 例。检测到 7 例 II 型内漏和 3 例 III 型内漏。平均 29.4±15.5 个月随访期间，无死亡病例。4 例患者中有 3 例肾动脉和 1 例髂外动脉闭塞。无其他新发重大不良事件。无需再次介入治疗。1 例 II 型内漏自发缓解，其余 6 例保持稳定。1 例早期 III 型内漏减少，1 例新发生 III 型内漏发生在 2 个月时。TV 的一期通畅率为 96.8%（120/124）。38 例患者（97.4%）可见动脉瘤直径缩小或稳定。假腔血栓形成率为 89.7%（35/39）。
本研究显示 PM-F/BEVAR 治疗 PD-TAAAs 的结果令人鼓舞。
4 级，病例系列。
