Fujioka Shunichiro, Kitamura Tadashi, Mishima Toshiaki, Mori Hisaya, Fukuzumi Masaomi, Shikata Fumiaki, Miyaji Kagami
Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Ann Vasc Dis. 2023 Sep 25;16(3):189-194. doi: 10.3400/avd.oa.23-00012.
Since 2018, we have routinely placed an Amplatzer vascular plug (AVP) in the proximal left subclavian artery (LSCA) to prevent embolic events during thoracic endovascular aortic repair with arch vessel debranching (d-TEVAR). Type II endoleaks of LSCA origin were observed in two patients (20%), and the coil-in-plug (CIP) method, i.e., microcatheter insertion through the plug and addition of coil embolization, which has been used since August 2019, was performed. This study aims to evaluate the effectiveness of the CIP method for LSCA embolization. A total of 26 patients who underwent d-TEVAR for an aortic arch aneurysm between 2018 and 2022 were retrospectively reviewed. Ten patients who underwent d-TEVAR with a simple AVP placement (the control group) and 16 patients who underwent d-TEVAR with the CIP method (the CIP group) were compared. : Two patients had type II endoleaks in the control group, whereas none had them in the CIP group. LSCA length was significantly shorter in patients with endoleaks than in those without endoleaks (24.5 vs. 50.3 mm; p<0.01). No perioperative deaths or cerebral infarctions occurred in either group. AVP placement in the LSCA during d-TEVAR effectively prevented perioperative cerebral infarction. d-TEVAR with CIP was especially useful in patients with a short LSCA.
自2018年以来，我们在胸主动脉腔内修复术（d-TEVAR）并行弓上血管去分支时，常规在左锁骨下动脉（LSCA）近端置入Amplatzer血管封堵器（AVP），以预防栓塞事件。在两名患者（20%）中观察到起源于LSCA的II型内漏，并采用了自2019年8月以来使用的封堵器内线圈（CIP）方法，即通过封堵器插入微导管并追加线圈栓塞。本研究旨在评估CIP方法用于LSCA栓塞的有效性。回顾性分析了2018年至2022年间接受d-TEVAR治疗主动脉弓动脉瘤的26例患者。比较了10例单纯置入AVP的d-TEVAR患者（对照组）和16例采用CIP方法的d-TEVAR患者（CIP组）。结果显示：对照组有2例发生II型内漏，而CIP组无此类情况。发生内漏的患者LSCA长度明显短于未发生内漏的患者（24.5 vs. 50.3 mm；p<0.01）。两组均未发生围手术期死亡或脑梗死。d-TEVAR期间在LSCA置入AVP可有效预防围手术期脑梗死。采用CIP的d-TEVAR对LSCA较短的患者尤其有用。
