Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
J Vasc Surg. 2022 Dec;76(6):1440-1448. doi: 10.1016/j.jvs.2022.08.018. Epub 2022 Aug 23.
Endovascular repair of post-type A aortic dissection (PTAD) after open ascending replacement has recently been shown as safe and feasible, but with limited anatomic applicability because only one stent graft was evaluated. We assessed anatomic and clinical applicability of six commercially available branched/fenestrated stent grafts for endovascular repair of PTAD.
On postoperative CT scans of 101 patients, we measured the aortic diameter at the sinutubular junction, supra-aortic vessels, and descending aorta, as well as the distances between these landmarks along the outer curvature of the arch and the diameters of the supra-aortic vessel. Anatomic applicability was evaluated according to the instructions for use, clinical applicability with regard to supra-aortic and iliac arteries. Assessed devices were the Cook aortic double branch, Terumo double branch, Najuta fenestrated, Endospan Nexus, Medtronic Mona LSA, and Gore TAG thoracic branch.
Single devices were anatomically and clinically applicable between 19 of 101 (Mona LSA) and 83 of 101 (Najuta) cases. Reasons for rejection varied considerably across devices. With all devices available, anatomic applicability was 97 of 101 and clinical applicability 95 of 101. Combinations of a fenestrated and a branched device showed the most favorable clinical applicability for a pair of two devices, ranging from 86 of 101 to 94 of 101.
Anatomic and clinical applicability of endovascular devices for the repair of PTAD is high for fenestrated and branched devices, and very high for the combination of fenestrated and branched devices. Manufacturers should amend specific device requirements for PTAD. Surgeons should emphasize the need for a sufficiently long and straight graft as a potential landing zone.
开放升主动脉置换术后的 A 型主动脉夹层（PTAD）的血管内修复最近已被证明是安全且可行的，但由于仅评估了一个支架移植物，因此具有有限的解剖适用性。我们评估了六种市售的分支/开窗支架移植物在 PTAD 的血管内修复中的解剖和临床适用性。
在 101 例患者的术后 CT 扫描上，我们测量了窦管交界、升主动脉和降主动脉的主动脉直径，以及这些标志之间沿弓外曲度的距离和升主动脉直径。根据使用说明评估解剖适用性，根据升主动脉和髂动脉评估临床适用性。评估的器械为 Cook 主动脉双分支、Terumo 双分支、Najuta 开窗、Endospan Nexus、Medtronic Mona LSA 和 Gore TAG 胸部分支。
在 101 例患者中，19 例（Mona LSA）至 83 例（Najuta）单器械具有解剖学和临床适用性。拒绝的原因在不同器械之间差异很大。所有器械均可应用时，解剖学适用性为 101 例中的 97 例，临床适用性为 101 例中的 95 例。使用一种开窗和一种分支器械的组合显示出最有利于双器械配对的临床适用性，范围为 101 例中的 86 例至 94 例。
用于修复 PTAD 的血管内器械的解剖学和临床适用性对于开窗和分支器械较高，对于开窗和分支器械的组合则非常高。制造商应修改针对 PTAD 的特定器械要求。外科医生应强调作为潜在着陆区的足够长且直的移植物的必要性。
