采用开窗式外科医生改良支架型人工血管行胸主动脉腔内修复术治疗累及主动脉弓的B型主动脉夹层的疗效
Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-graft for type B aortic dissections involving the aortic arch.
作者信息
Li Xiaoye, Zhang Lei, Song Chao, Zhang Hao, Xia Shibo, Yang Yang, Zhu Longtu, Guo Wenying, Lu Qingsheng
机构信息
Division of Vascular Surgery, Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
Changhai Hospital, Naval Medical University, Shanghai, China.
出版信息
Front Cardiovasc Med. 2023 Jan 16;9:1031068. doi: 10.3389/fcvm.2022.1031068. eCollection 2022.
OBJECTIVES
This retrospective analysis aimed to evaluate the early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) with fenestrated surgeon-modified stent-graft (f-SMSG) for type B aortic dissections (TBAD) involving the aortic arch.
METHODS
From March 2016 to April 2021, 47 consecutive patients were treated using TEVAR with f-SMSG. All patients were diagnosed with TBAD involving the aortic arch.
RESULTS
In total, 47 patients with TBAD involving the aortic arch were treated with f-SMSGs. There were 21 zone 1 and 26 zone 2 TEVAR, and 65 arteries were revascularized successfully with fenestrations. Technical success was achieved in 46 patients (97.88%). The 30-day estimated survival (± SE) and reintervention was 93.6 ± 1.0% (95% Confidence Interval [CI], 92.6-94.6%) and 91.5 ± 1.2% (95% CI, 90.3-92.7%), respectively. During a median follow-up of 51 months (range, 16-71 months), 1 patient died of rupture of aortic dissection (AD) and 3 patients died of non-aortic-related reasons. Reintervention was performed for four patients, including two patients of type IA entry flow and two patients of type IB entry flow. No occlusion of the supra-aortic trunk was observed. The estimated survival and reintervention (± SE) at 4 years was 88.7 ± 1.4% (95% CI, 87.3-90.1%) and 84.8 ± 1.5% (95% CI, 83.3-86.3%), respectively.
CONCLUSION
Thoracic endovascular aortic repair with f-SMSG is an alternative treatment option for TBAD involving the aortic arch in high-volume centers.
目的
本回顾性分析旨在评估使用开窗式外科医生改良支架移植物（f-SMSG）进行胸主动脉腔内修复术（TEVAR）治疗累及主动脉弓的B型主动脉夹层（TBAD）的早期和中期结果。
方法
2016年3月至2021年4月，连续47例患者接受了使用f-SMSG的TEVAR治疗。所有患者均被诊断为累及主动脉弓的TBAD。
结果
共有47例累及主动脉弓的TBAD患者接受了f-SMSG治疗。其中21例为1区TEVAR，26例为2区TEVAR，65条动脉通过开窗成功实现血运重建。46例患者（97.88%）实现了技术成功。30天估计生存率（±标准误）和再次干预率分别为93.6±1.0%（95%置信区间[CI]，92.6 - 94.6%）和91.5±1.2%（95%CI，90.3 - 92.7%）。在中位随访51个月（范围16 - 71个月）期间，1例患者死于主动脉夹层（AD）破裂，3例患者死于非主动脉相关原因。4例患者接受了再次干预，包括IA型入口血流2例和IB型入口血流2例。未观察到主动脉弓上主干闭塞。4年时的估计生存率和再次干预率（±标准误）分别为88.7±1.4%（95%CI，87.3 - 90.1%）和84.8±1.5%（95%CI，83.3 - 86.3%）。
结论
在大容量中心，使用f-SMSG进行胸主动脉腔内修复术是治疗累及主动脉弓的TBAD的一种替代治疗选择。
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