Wen Qinshu, Wu Guangyan, Ji Ye, Yang Guangmin, Zhang Yepeng, Li Wendong, Du Xiaolong, Li Xiaoqiang, Zhou Min
Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Department of Vascular Surgery, Medical School of Southeast University, Nanjing Drum Tower Hospital, Nanjing, China.
J Endovasc Ther. 2023 Oct 30:15266028231207023. doi: 10.1177/15266028231207023.
This study aimed to evaluate the outcomes of physician-modified endografts (PMEGs) for the treatment of thoracic aortic pathologies involving the aortic arch.
A retrospective single-center study was performed on consecutive patients with thoracic aortic pathologies treated by PMEGs between February 2018 and May 2022. Data on baseline characteristics, operative procedure, and follow-up information were collected. The endpoints included technical success, complications, mortality, overall survival, re-intervention, and target vessel instability.
This study comprised 173 patients (mean age=58±13, range=28-83, 148 men) with thoracic aortic pathologies, including 44 thoracic aortic aneurysms, 113 aortic dissections (9 type A, 4 residual type A, 75 type B, 32 non-A non-B), 3 aortic intramural hematomas, and 13 penetrating aortic ulcers. Thirty-five of the patients had PMEGs with 3 fenestrations, 32 had 2 fenestrations, and 106 had 1 single fenestration. Technical success was 98% (170/173), and the 30-day mortality was 2% (3/173). Perioperative complications included stroke (n=3, 2%), retrograde type A dissection (RTAD; n=3, 2%) and renal injury (n=3, 2%). Seven deaths (4%) were noted during a median follow-up of 11 (range=1-52) months. Eleven cases of re-intervention were stent-related. There were 5 type Ia endoleaks (3%), 2 type III endoleaks (1%) from the innominate artery (IA), and 3 type Ic endoleaks (2%) from the left subclavian arteries. One case of IA stent-graft (SG) stenosis was noted because of mural thrombus. Estimate rates of overall survival, freedom from secondary intervention, and freedom from target vessel instability at 2 years were 93.4% (95% confidence interval [CI]=88.7%-98.1%), 80.7% (95% CI=73.3%-88.1%), and 89.0% (95% CI=80.4%-97.6%), respectively.
Physician-modified endografts showed promising immediate therapeutic results in the treatment of thoracic aortic pathologies involving the aortic arch. Our study demonstrates that the technique is feasible and produces acceptable results. Long-term outcomes are required for further refinement of this technical approach to confirm technical success and durability over time as a valuable option for endovascular aortic arch repair in specialized centers.
Our short- and mid-term outcomes of physician-modified endografts in 173 patients showed promising results compared to other branched/fenestrated techniques and backed up the endovascular repair of the aortic arch. Meanwhile, the technical expertise pointed out in our manuscript, including preloaded guidewire, diameter-reducing wire and inner mini-cuffs, provided reference and technical guidance for our peers. Most importantly, it demonstrated that the PMEG, as a device whose components were all commercially available, might be a better option for emergency surgery and for centers who had no access to custom-made devices.
本研究旨在评估经医生改良的腔内移植物（PMEG）治疗累及主动脉弓的胸主动脉病变的效果。
对2018年2月至2022年5月期间连续接受PMEG治疗的胸主动脉病变患者进行回顾性单中心研究。收集基线特征、手术过程及随访信息的数据。终点指标包括技术成功、并发症、死亡率、总生存率、再次干预及靶血管不稳定情况。
本研究纳入173例胸主动脉病变患者（平均年龄=58±13岁，范围=28 - 83岁，男性148例），包括44例胸主动脉瘤、113例主动脉夹层（9例A型、4例残留A型、75例B型、32例非A非B型）、3例主动脉壁内血肿及13例穿透性主动脉溃疡。其中35例患者使用的PMEG有3个开窗，32例有2个开窗，106例有1个单开窗。技术成功率为98%（170/173），30天死亡率为2%（3/173）。围手术期并发症包括卒中（n = 3，2%）、逆行A型夹层（RTAD；n = 3，2%）和肾损伤（n = 3，2%）。在中位随访11个月（范围=1 - 52个月）期间有7例死亡（4%）。11例再次干预与支架相关。有5例Ia型内漏（3%），2例来自无名动脉（IA）的III型内漏（1%），3例来自左锁骨下动脉的Ic型内漏（2%）。有1例因壁内血栓导致IA支架移植物（SG）狭窄。2年时的总生存率、免于二次干预率及免于靶血管不稳定率估计分别为93.4%（95%置信区间[CI]=88.7% - 98.1%）、80.7%（95% CI = 7
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