Teymouri Mehdi, Mehta Manish, Paty Philip, Jayakumar Lalithapriya, Kostun Zachary W
Vascular Health Partners, Latham, NY.
J Vasc Surg Cases Innov Tech. 2023 Mar 23;9(2):101111. doi: 10.1016/j.jvscit.2023.101111. eCollection 2023 Jun.
To the best of our knowledge, the present report is the first on the safety and efficacy of complete endovascular aortic reconstruction from zone 0 to 10 using a standardized approach and parallel stent graft configurations in high-risk patients considered unfit for surgery. During a 7-year period, five patients with complex thoracoabdominal aortic aneurysms and dissections involving zone 0-10 presented with rupture (n = 1; 20%), were symptomatic (n = 2; 40%), or had an aortic pseudoaneurysm (n = 2; 40%) and underwent complete endovascular zone 0-10 reconstruction using off-the-shelf stent grafts in parallel configurations that included chimneys, periscopes, and endovascular docking stations. The zone 0-5 complete arch chimney thoracic endovascular repair included chimneys that extended from the ascending thoracic aorta to the innominate, left common carotid, and left subclavian arteries and a thoracic stent graft extending from zone 0 to 5. The zone 5-10 aortic reconstructions were staged. Stage 1 included either thoracic stent graft and antegrade four visceral chimney placement or abdominal aortic stent graft and retrograde four visceral chimney placement. Stage II included completion of the remainder of the aortic reconstruction with cerebrospinal fluid drainage. A total of 15 aortic procedures included 34 chimneys (14 aortic arch and 20 visceral). Two patients (40%) underwent zone 0-5 aortic reconstruction first, and three patients (60%) underwent zone 5-10 aortic reconstruction first. The incidence of 30-day mortality, spinal cord ischemia, myocardial infarction, stroke, and visceral ischemia was 0%. At a mean follow-up of 4.5 ± 3.1 years, the aortic reconstruction-related mortality was 0%. All-cause mortality was 20%; one patient had died of pneumonia at 3 years postoperatively. Two endoleaks each occurred in zone 0-5 and zone 5-10 (40% for both groups). All endoleaks were treated with coil embolization. Complete endovascular zone 0-10 aortic reconstruction using parallel stent grafts with a docking station is a feasible and relatively safe technique that offers the ability to customize off-the-shelf devices for the treatment of high-risk patients with limited morbidity and mortality.
据我们所知，本报告首次阐述了在被认为不适合手术的高危患者中，使用标准化方法和并行支架移植物配置，从0区到10区进行全腔内主动脉重建的安全性和有效性。在7年期间，5例累及0 - 10区的复杂胸腹主动脉瘤和夹层患者，其中1例（20%）出现破裂，2例（40%）有症状，2例（40%）有主动脉假性动脉瘤，他们接受了使用现成的并行配置支架移植物（包括烟囱式、潜望镜式和腔内对接站）进行的全腔内0 - 10区重建。0 - 5区全弓烟囱式胸主动脉腔内修复包括从胸主动脉升部延伸至无名动脉、左颈总动脉和左锁骨下动脉的烟囱式支架以及从0区延伸至5区的胸段支架移植物。5 - 10区主动脉重建分阶段进行。第一阶段包括胸段支架移植物及顺行四内脏烟囱式支架置入或腹主动脉支架移植物及逆行四内脏烟囱式支架置入。第二阶段包括在脑脊液引流辅助下完成主动脉重建的其余部分。总共15例主动脉手术包括34个烟囱式支架（14个主动脉弓部和20个内脏部）。2例患者（40%）先进行了0 - 5区主动脉重建，3例患者（60%）先进行了5 - 10区主动脉重建。30天死亡率、脊髓缺血、心肌梗死、中风和内脏缺血的发生率均为0%。平均随访4.5±3.1年，与主动脉重建相关的死亡率为0%。全因死亡率为20%；1例患者术后3年死于肺炎。0 - 5区和5 - 10区各发生2例内漏（两组均为40%）。所有内漏均采用弹簧圈栓塞治疗。使用带对接站的并行支架移植物进行全腔内0 - 10区主动脉重建是一种可行且相对安全的技术，能够定制现成设备，用于治疗发病率和死亡率有限的高危患者。
