Department of Vascular and Thyroid Surgery, The First Hospital, China Medical University, 155 Nanjing Bei St, Shenyang, China.
Department of Anesthesiology, the First Hospital, China Medical University, 155 Nanjing Bei St, Shenyang, China.
Cardiovasc Intervent Radiol. 2023 Oct;46(10):1315-1328. doi: 10.1007/s00270-023-03537-4. Epub 2023 Sep 8.
To compare the technical and clinical outcomes of fenestrated thoracic endovascular aortic repair (F-TEVAR) and chimney thoracic endovascular aortic repair (CH-EVAR) of aortic disease.
PubMed, Embase and Cochrane databases were systematically searched to identify studies on the management of thoracic aortic pathologies using chimney or fenestrated techniques published between 2000 and 2022. Individual studies provided at least one of the following essential outcomes: technical success, immediate and follow-up type I endoleak, 30-day and aorta-related mortality, cerebral events and supra-aortic branch patency.
24 chimney (1106 patients) and 21 fenestrated technique studies (1040 patients) were included. The scope of the study encompassed various thoracic aortic conditions, such as thoracic aortic dissection, thoracic aortic aneurysm, thoracic aortic ulcer, and other thoracic aortic diseases. Technical success was defined as the handling of the principal ailment affecting the aorta, devoid of any instances of complications. The technical success rates were higher in fenestrated group compared with chimney group (98.0% vs. 95.8% p < 0.001), and the rate of type I endoleak either immediately or during follow-up was higher in the chimney technique group (9.3% vs. 1.3% p < 0.001, 4.0% vs. 0.0% p < 0.001). The chimney technique group had higher 30-day mortality and aorta-related mortality than those in the fenestrated technique group (2.1% vs. 0.3% p < 0.001, 0.4% vs. 0.0% p < 0.001). Morbidity rates of cerebral events and supra-aortic branch patency were same in both groups (2.2% vs. 1.1% p = 0.116, 98.2% vs. 99.4% p = 0.094). The chimney technique group had longer operative time (110.0 min vs. 90.8 min p < 0.001). Two groups had same fluoroscopy time (34.0 min vs. 33.4 min p = 0.614).
The finding suggest that both the chimney and fenestrated techniques are efficacious in supra-aortic branch reconstruction. However, the fenestrated technique exhibits potential superiority as an interventional strategy, as it demonstrates a lower incidence of type 1 Endoleak, 30-day mortality, and aorta-related death following TEVAR.
比较开窗和烟囱胸主动脉腔内修复术（TEVAR）治疗主动脉疾病的技术和临床结果。
系统检索了 2000 年至 2022 年间发表的使用烟囱或开窗技术治疗胸主动脉病变的文献，纳入了至少提供以下一项基本结果的研究：技术成功率、即刻和随访 I 型内漏、30 天和主动脉相关死亡率、脑卒中和主动脉上分支通畅率。
共纳入 24 项烟囱技术（1106 例患者）和 21 项开窗技术研究（1040 例患者）。研究范围涵盖了各种胸主动脉疾病，如胸主动脉夹层、胸主动脉瘤、胸主动脉溃疡和其他胸主动脉疾病。技术成功定义为处理主要影响主动脉的疾病，无任何并发症。开窗组的技术成功率高于烟囱组（98.0%比 95.8%，p<0.001），烟囱组即刻和随访时 I 型内漏的发生率高于开窗组（9.3%比 1.3%，p<0.001；4.0%比 0.0%，p<0.001）。烟囱组 30 天死亡率和主动脉相关死亡率高于开窗组（2.1%比 0.3%，p<0.001；0.4%比 0.0%，p<0.001）。两组脑卒中和主动脉上分支通畅率相似（2.2%比 1.1%，p=0.116；98.2%比 99.4%，p=0.094）。烟囱组的手术时间较长（110.0 分钟比 90.8 分钟，p<0.001）。两组的透视时间相同（34.0 分钟比 33.4 分钟，p=0.614）。
研究结果表明，烟囱和开窗技术在主动脉上分支重建中均有效。然而，开窗技术作为一种介入策略具有潜在优势，因为它在 TEVAR 后发生 I 型内漏、30 天死亡率和主动脉相关死亡率的风险较低。
