Sun Yanfeng, Zhang Yang, Sun Xiwei, Yin Hang, Wang Shuai, Li Xiao, Wang Zhongying, Luo Sean X, Cheng Zhihua
Department of Vascular Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, China.
Front Bioeng Biotechnol. 2023 Jul 20;11:1240651. doi: 10.3389/fbioe.2023.1240651. eCollection 2023.
Complex aortic lesions, especially those involving branches of the visceral artery, remain a challenge to treat. A single-center study using the Octopus technique to evaluate the safety and short-term effects of endovascular repair of complex aortic lesions was reported and documented. The data of six cases who underwent optimized Octopus surgery in our center from August 2020 to February 2022 were analyzed retrospectively. The choice of operation scheme, operation time, operation complications, and follow-up data were analyzed among them. The average age of the six patients undergoing optimized Octopus surgery was 55.1 ± 17.2 years. Two cases were diagnosed as pararenal aortic aneurysms; four cases were aortic dissection involving the visceral artery. All cases achieved technical success; all visceral arteries were reconstructed as planned. A total of 17 visceral arteries were planned to be reconstructed; five celiac arteries were embolized. Three cases of gutter endoleak were found during the operation without embolization but with follow-up observation. There were two cases of slight damage to renal function and two cases of perioperative death. Other complications, such as intestinal ischemia and spinal cord ischemia, did not occur. Follow-up ranged from 6 months to 30 months. One patient died of gastrointestinal bleeding 6 months after the operation. At the 6 months follow-up, computed tomographic angiography showed that all internal leaks had disappeared. The patency rate of the visceral artery was 100%, and no complications, such as stent displacement and occlusion, occurred during the follow-up period. With fenestrated and branched stent grafts technology not widely available, and off label use not a viable option, Octopus technology for treating complex aortic lesions should be considered. The Octopus technique is an up-and-coming surgical method, but we should recognize its operation difficulty, operation-related complications, and long-term prognosis. We should pay attention to and continue to optimize Octopus technology.
复杂的主动脉病变，尤其是那些涉及内脏动脉分支的病变，在治疗上仍然是一项挑战。一项单中心研究报告并记录了使用章鱼技术评估复杂主动脉病变血管内修复的安全性和短期效果。回顾性分析了2020年8月至2022年2月在我们中心接受优化章鱼手术的6例患者的数据。分析了其中的手术方案选择、手术时间、手术并发症及随访数据。接受优化章鱼手术的6例患者平均年龄为55.1±17.2岁。2例诊断为肾旁主动脉瘤；4例为累及内脏动脉的主动脉夹层。所有病例均取得技术成功；所有内脏动脉均按计划重建。共计划重建17条内脏动脉；5条腹腔干动脉被栓塞。术中发现3例沟内漏，未进行栓塞，而是进行了随访观察。有2例肾功能轻度受损，2例围手术期死亡。未发生其他并发症，如肠缺血和脊髓缺血。随访时间为6个月至30个月。1例患者术后6个月死于消化道出血。在6个月随访时，计算机断层血管造影显示所有内漏均消失。内脏动脉通畅率为100%，随访期间未发生支架移位和闭塞等并发症。由于开窗和分支支架移植物技术尚未广泛应用，且超适应证使用不是一个可行的选择，应考虑使用章鱼技术治疗复杂主动脉病变。章鱼技术是一种新兴的手术方法，但我们应认识到其手术难度、手术相关并发症及长期预后。我们应关注并继续优化章鱼技术。
