Ferraresi Marco, Katsarou Maria, Luigi Molinari Alessandro Carlo, Segreti Sara, Rossi Giovanni
Division of Vascular Surgery, Cardio-Thoracic-Vascular Department, Alessandro Manzoni Hospital, Lecco, Italy.
J Vasc Surg Cases Innov Tech. 2024 Feb 14;10(3):101455. doi: 10.1016/j.jvscit.2024.101455. eCollection 2024 Jun.
The number of vascular centers performing endovascular repair of ascending aortic disease is constantly increasing. Accordingly to the guidelines, open surgical repair remains the gold standard for these pathologies. However, approximately one quarter of patients are deemed unfit for open surgery. In this study, we describe three cases of ascending thoracic endovascular aortic repair (TEVAR) performed at our center. All the patients were deemed unfit for open surgery by the aortic team. Two patients had an ascending aortic pseudoaneurysm, and the third had a focal type A aortic dissection. In two cases, we used two abdominal aortic cuffs deployed from zone 0B to zone 0C, with no need for supra-aortic trunk debranching. In one case, we performed a "reverse" extrathoracic debranching, and we deployed a thoracic endograft from zone 0B to zone 2. Complications included one minor stroke and one inguinal hematoma. In one patient with an infected pseudoaneurysm, we performed ascending TEVAR as a bridge strategy for open repair. This patient developed a type Ia endoleak; however, clinical stabilization and infection control were obtained, and he was able to undergo heart surgery successfully. He underwent a second reintervention to treat superior mesenteric embolic occlusion. At 2 years of follow-up, all three patients were alive. Our preliminary experience demonstrates the technical feasibility and clinical appropriateness of ascending TEVAR using standard, commercially available endografts. However, no consensus has been reached regarding some critical aspects, such as the development of a standardized technique or the efficacy of the currently available devices. The improvements in graft design and the adoption of the "aortic team" approach could help in the near future to standardize the procedure, establish appropriate indications, and ensure good clinical outcomes.
开展升主动脉疾病血管腔内修复术的血管中心数量在不断增加。根据指南，开放手术修复仍是这些病变的金标准。然而，约四分之一的患者被认为不适合进行开放手术。在本研究中，我们描述了在我们中心进行的3例升主动脉腔内修复术（TEVAR）。所有患者均被主动脉团队认为不适合进行开放手术。2例患者患有升主动脉假性动脉瘤，第3例患者患有局灶性A型主动脉夹层。在2例病例中，我们使用了从0B区至0C区置入的2个腹主动脉袖套，无需进行主动脉弓上分支血管离断术。在1例病例中，我们进行了“反向”胸外分支血管离断术，并从0B区至2区置入了胸段血管内移植物。并发症包括1例轻度卒中及1例腹股沟血肿。在1例患有感染性假性动脉瘤的患者中，我们进行了升主动脉TEVAR作为开放修复的过渡策略。该患者出现了Ia型内漏；然而，实现了临床稳定和感染控制，并且他能够成功接受心脏手术。他接受了第二次再次干预以治疗肠系膜上动脉栓塞性闭塞。在随访2年时，所有3例患者均存活。我们的初步经验证明了使用标准的、市售血管内移植物进行升主动脉TEVAR的技术可行性和临床适用性。然而，在一些关键方面尚未达成共识，例如标准化技术的发展或现有器械的疗效。移植物设计的改进以及“主动脉团队”方法的采用可能在不久的将来有助于使该手术标准化、确立合适的适应证并确保良好的临床结果。
