Lu Zhexin, Huang Jin, Fan Yongliang, Gu Hongbing, Zhu Xian, Yu Min, Ye Yizhou
Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
Department of Nursing, Shanghai East Hospital, Tong Ji University, School of Medicine, Shanghai, China.
J Med Imaging Radiat Oncol. 2024 Feb;68(1):79-86. doi: 10.1111/1754-9485.13572. Epub 2023 Aug 31.
Ascending aorta or hemi-arch replacement is a frequently used treatment for patients with acute type A thoracic aortic dissection, particularly those who are elderly or have multiple comorbidities. However, in cases where there are secondary entry tears in the aortic arch or descending aorta, this procedure may not fully resolve the issue. The true lumen may remain compressed due to perfusion of the false lumen and usually require reoperation.
Between January 2019 and July 2022, 18 patients underwent endovascular total aortic arch repair and fenestration technique without requiring median re-sternotomy. Aortic stent grafts were implanted via the femoral approach, utilizing prosthetic vessels as an appropriate proximal landing zone for aortic stent graft deployment. Based on the debranching conditions of the arch in previous surgery, single, double or triple in situ fenestrations (ISFs) were performed, respectively.
All 18 cases were technically successful, with a median follow-up period of 20 months (range: 18-31 months). All patients had a favourable postoperative course, with no deaths within 30 days or during their hospital stay. There were no instances of disabling stroke, paraplegia, endo-leak, stent graft migration or stent graft-induced new entry. In addition, all patients exhibited complete thrombosis of the false lumen at the level of the aortic arch.
Our preliminary experience suggests that endovascular total arch repair combined with ISF technique is a viable, effective and safe option for treatment. Our mid-term results have been promising, but we acknowledge the need for further evaluation to assess long-term outcomes and durability.
升主动脉或半弓置换术是治疗急性A型胸主动脉夹层患者常用的方法，特别是对于老年患者或患有多种合并症的患者。然而，在主动脉弓或降主动脉存在继发破口的情况下，该手术可能无法完全解决问题。由于假腔的灌注，真腔可能仍然受压，通常需要再次手术。
在2019年1月至2022年7月期间，18例患者接受了无需正中再次开胸的血管腔内全主动脉弓修复和开窗技术。通过股动脉途径植入主动脉覆膜支架移植物，利用人工血管作为主动脉覆膜支架移植物展开的合适近端着陆区。根据既往手术中弓部的去分支情况，分别进行单、双或三原位开窗（ISF）。
所有18例手术均技术成功，中位随访期为20个月（范围：18 - 31个月）。所有患者术后病程良好，30天内或住院期间无死亡。无致残性中风、截瘫、内漏、支架移植物移位或支架移植物引起的新破口发生。此外，所有患者在主动脉弓水平的假腔均完全血栓形成。
我们的初步经验表明，血管腔内全弓修复联合ISF技术是一种可行、有效且安全的治疗选择。我们的中期结果很有前景，但我们承认需要进一步评估以评估长期结果和耐久性。
