Abisi Said, Elnemr Mohamed, Clough Rachel, Alotaibi Mohammed, Gkoutzios Panos, Modarai Bijan, Haulon Stephan
Guy's and St Thomas' NHS Foundation Trust, London, UK.
Faculty of Life Sciences & Medicine, King's College London, London, UK.
J Endovasc Ther. 2025 Jun;32(3):730-738. doi: 10.1177/15266028231184687. Epub 2023 Jul 4.
The main objective of this study is to present the experience of 2 centers undertaking total percutaneous aortic arch-branched graft endovascular repair using combination of femoral and axillary routes. The report summarizes the procedural steps, outcomes achieved, and the benefits of this approach, which eliminates the need for direct open surgical exposure of the carotid, subclavian, or axillary arteries, thereby reducing the unnecessary associated surgical risks.
Retrospectively collected data of 18 consecutive patients (15M:3F) undergoing aortic arch endovascular repair using a branched device between February 2021 and June 2022 at 2 aortic units. Six patients were treated for a residual aortic arch aneurysm following previous type A dissection with size range of (58-67 mm in diameter), 10 were treated for saccular or fusiform degenerative atheromatous aneurysm with size range of (51.5-80 mm in diameter), and 2 were treated for penetrating aortic ulcer (PAU) with size range of (50-55 mm). Technical success was defined as completion of the procedure and satisfactory placement of the bridging stent grafts (BSGs) in the supra-aortic vessels percutaneously including the brachiocephalic trunk (BCT), left common carotid artery (LCCA), and left subclavian artery (LSA) without the need for carotid, subclavian, or axillary cut down. The primary technical success was examined as primary outcome well as any other related complications and reinterventions as secondary outcomes.
The primary technical success with our alternative approach was achieved in all 18 cases. There was one access site complication (groin haematoma), which was managed conservatively. There was no incidence of death, stroke, or cases of paraplegia. No other immediate complications were noted. Postoperative imaging confirmed supra-aortic branch patency, with satisfactory position of the BSGs and immediate aneurysm exclusion except in 4 patients who had type 1C endoleak (Innominate: 2, LSA 2) detected on the first postoperative scan. Three of them were treated with relining/extension, and 1 spontaneously resolved after 6 weeks.
Total percutaneous aortic arch repair with antegrade and retrograde inner-branch endografts can be performed with promising early results. Dedicated steerable sheaths and appropriate BSG would optimize the percutaneous approach for aortic arch endovascular repairs.Clinical ImpactThis article provides an alternative and innovative approach to improve the minimally invasive techniques in the endovascular treatment of the aortic arch conditions.
本研究的主要目的是介绍两个中心采用股动脉和腋动脉联合入路进行全经皮主动脉弓分支移植物血管腔内修复的经验。本报告总结了手术步骤、取得的结果以及这种方法的益处，该方法无需直接开放手术暴露颈动脉、锁骨下动脉或腋动脉，从而降低了不必要的相关手术风险。
回顾性收集了2021年2月至2022年6月期间在两个主动脉治疗单元接受使用分支装置进行主动脉弓血管腔内修复的18例连续患者（15例男性：3例女性）的数据。6例患者因既往A型夹层后残留主动脉弓动脉瘤接受治疗，动脉瘤直径范围为（58 - 67毫米），10例患者因囊状或梭形退行性动脉粥样硬化性动脉瘤接受治疗，直径范围为（51.5 - 80毫米），2例患者因穿透性主动脉溃疡（PAU）接受治疗，直径范围为（50 - 55毫米）。技术成功定义为手术完成且桥接支架移植物（BSG）在经皮主动脉弓血管（包括头臂干（BCT）、左颈总动脉（LCCA）和左锁骨下动脉（LSA））中满意放置，无需进行颈动脉、锁骨下动脉或腋动脉切开。将主要技术成功作为主要结局进行评估，将任何其他相关并发症和再次干预作为次要结局进行评估。
所有18例患者均通过我们的替代方法取得了主要技术成功。发生了1例入路部位并发症（腹股沟血肿），经保守治疗。无死亡、中风或截瘫病例。未发现其他即刻并发症。术后影像学检查证实主动脉弓分支通畅，BSG位置满意且动脉瘤即刻被隔绝，但有4例患者在术后首次扫描时发现1C型内漏（无名动脉：2例，左锁骨下动脉2例）。其中3例接受了内衬/延伸治疗，1例在6周后自发缓解。
采用顺行和逆行内分支移植物进行全经皮主动脉弓修复可取得有前景的早期结果。专用的可操纵鞘管和合适的BSG将优化主动脉弓血管腔内修复的经皮入路。临床影响本文提供了一种替代的创新方法，以改进主动脉弓疾病血管腔内治疗中的微创技术。
