Kursch Florian, Doukas Panagiotis
Department of Vascular and Endovascular Surgery, University Hospital Cologne, Cologne, Germany.
European Vascular Center Aachen Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany.
Innov Surg Sci. 2023 Dec 18;8(4):203-207. doi: 10.1515/iss-2023-0029. eCollection 2023 Dec.
The gold standard for the treatment of pathologies of the aortic arch remains the open surgical reconstruction of the affected segments. However, endovas-cular treatment options have emerged that eliminate the need for invasive open surgery. Several endograft devices - with fenestrations or branches for the supraaortic vessels - are currently available to address different pathologies and anatomical variations. Parallel-graft techniques and fenestrations expand the treatment options for emergent cases. In this selective review of the literature of 2020 and 2021, we summarize the current chances and challenges of endovascular aortic repair.
Reported mortality rates range from 0 to 13.2 %. Although technical success rates for fenestrated and branched devices are promising (98 %), stroke rates remain a relevant issue (10 and 3 % for BTEVAR and FTEVAR respectively). The reported technical success rate for fenestrations is also encouraging (94 %) and the stroke rates acceptable (5 %). Parallel-graft techniques are associated with high early and late endoleak rates (early 76 %; late 31 %), but still hold a valuable place in the treatment of emergent cases or in bail-out situations.
The endovascular repair of the aortic arch expands the range of patients with pathologies of the arch eligible for treatment to those unfit for open surgery offering a minimally invasive, yet technically challenging procedure. More data and meta-analyses are needed to define the benefits and drawbacks of this promising treatment option in an aging population with increasing co-morbidities.
主动脉弓病变治疗的金标准仍然是对受影响节段进行开放性手术重建。然而，已经出现了一些血管内治疗方案，无需进行侵入性开放性手术。目前有几种带开窗或分支的主动脉弓覆膜支架可供选择，以应对不同的病变和解剖变异。平行移植物技术和开窗技术扩大了急诊病例的治疗选择。在本次对2020年和2021年文献的选择性综述中，我们总结了血管内主动脉修复目前面临的机遇和挑战。
报告的死亡率在0%至13.2%之间。虽然开窗和分支型器械的技术成功率很可观（98%），但卒中发生率仍然是一个相关问题（分支型胸主动脉腔内修复术和开窗型胸主动脉腔内修复术的卒中发生率分别为10%和3%）。报告的开窗技术成功率也令人鼓舞（94%），卒中发生率也可接受（5%）。平行移植物技术与较高的早期和晚期内漏发生率相关（早期为76%；晚期为31%），但在急诊病例治疗或补救情况下仍占有重要地位。
主动脉弓的血管内修复将适合治疗的主动脉弓病变患者范围扩大到不适合开放性手术的患者，提供了一种微创但技术要求高的手术方法。需要更多的数据和荟萃分析来确定这种有前景的治疗方案在合并症日益增多的老年人群中的利弊。
