Moqaddam Mathieu, Bacri Christoph, Hireche Kheira, Alric Pierre, Canaud Ludovic
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
Physiology and Experimental Medicine of the Heart and Muscles, University of Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France.
JTCVS Tech. 2024 Mar 12;25:8-18. doi: 10.1016/j.xjtc.2024.03.003. eCollection 2024 Jun.
This study aims to assess the feasibility and effectiveness of physician-modified fenestrated stent grafts (PMEGs) in treating type 1a endoleak after conventional thoracic endovascular aortic repair (TEVAR) in aortic arch pathologies.
Patients who developed a type 1a endoleak after conventional TEVAR were included in the study. They underwent treatment with fenestrated PMEGs, which involved single or double fenestration for the supra-aortic trunks.
Twenty patients were treated with PMEGs between October 2018 and November 2023. Among them, 25% received single fenestrated PMEGs and 75% received double fenestrated PMEGs. The technical success rate was 100% for both types. Eighty percent of the PMEGs had a landing zone in zone 0, whereas 20% had a landing zone in zone 2. There were no in-hospital deaths. After 30 days, 1 patient died as the result of an aortic-related cause (retrograde dissection). The mean follow-up time was 16.5 months (range, 0-60 months). No major adverse events such as stroke or spinal ischemia were reported. No type 1 or type 3 endoleaks were observed, and one type 2 endoleaks required peripheral endovascular reintervention.
The treatment of type 1a endoleaks using fenestrated PMEGs after conventional TEVAR for aortic arch pathologies is a viable option. It is associated with acceptable rates of early and midterm major morbidity and mortality.
本研究旨在评估医生改良开窗支架移植物（PMEG）治疗主动脉弓病变传统胸主动脉腔内修复术（TEVAR）后1a型内漏的可行性和有效性。
纳入传统TEVAR术后发生1a型内漏的患者。他们接受了开窗PMEG治疗，其中包括对主动脉弓上分支进行单开窗或双开窗。
2018年10月至2023年11月期间，20例患者接受了PMEG治疗。其中，25%接受单开窗PMEG，75%接受双开窗PMEG。两种类型的技术成功率均为100%。80%的PMEG锚定区位于0区，20%的锚定区位于2区。无院内死亡病例。30天后，1例患者因主动脉相关原因（逆行夹层）死亡。平均随访时间为16.5个月（范围0 - 60个月）。未报告中风或脊髓缺血等重大不良事件。未观察到1型或3型内漏，1例2型内漏需要进行外周血管腔内再次干预。
对于主动脉弓病变，在传统TEVAR术后使用开窗PMEG治疗1a型内漏是一种可行的选择。它与可接受的早期和中期主要发病率和死亡率相关。
