Kurobe Hirotsugu, Hori Takaki, Fujita Hiroshi, Higaki Tomohide, Fukunishi Takuma, Sogabe Hitoshi, Izutani Hironori
Department of Cardiovascular & Thoracic Surgery, Graduate School of Medicine, EHIME University, Toon.
Division of Cardiovascular Surgery, Shinsenkai Imabari Daiichi Hospital, Imabari.
Ann Med Surg (Lond). 2024 Jun 13;86(8):4854-4860. doi: 10.1097/MS9.0000000000002268. eCollection 2024 Aug.
Elderly and frail patients with thoracic aortic aneurysms (TAAs) near to origins of cervical arteries present facing challenges with aortic arch replacement with cardiopulmonary bypass, and traditional tube-type stent-grafts are also inadequate for transcatheter endovascular aortic repair (TEVAR). Thus, necessitating precise treatment with fenestrated stent-grafts from zone 0. This approach is crucial for achieving favorable postoperative outcomes without compromising activities of daily living (ADL).
An 85-year-old-man admitted to the hospital for treatment of a large TAA. While arch replacement is a definitive procedure, it is highly invasive, and the postoperative ADL are expected to be significantly lower than preoperative levels. Therefore, we performed a debranching TEVAR from Zone 0 with fenestrated stent-graft. The patient was discharged from the hospital on the 11th postoperative day.
In frail and elderly patients for whom conventional surgery may not be viable, TEVAR emerges as a preferred alternative. However, TEVAR of TAA proximal to the aortic arch continues to pose challenges, necessitating meticulous attention to the cervical branches in the intervention strategy. While surgical intervention in these patients necessitates careful consideration of its suitability, including the potential for postoperative enhancement in ADL, the use of fenestrated stent-grafts from Zone 0 emerges as one of the treatment modalities.
The authors present a very elderly case in which fenestrated stent-grafts were used to avoid aortic arch replacement for a large aortic arch aneurysm, resulting in a good postoperative course with no decline in ADL.
患有靠近颈总动脉起源处胸主动脉瘤（TAA）的老年体弱患者，在进行体外循环下主动脉弓置换时面临挑战，传统的直管型覆膜支架移植物也不足以用于经导管主动脉腔内修复术（TEVAR）。因此，需要使用0区开窗覆膜支架移植物进行精准治疗。这种方法对于在不影响日常生活活动（ADL）的情况下实现良好的术后效果至关重要。
一名85岁男性因大型TAA入院治疗。虽然主动脉弓置换是一种确定性手术，但它具有高度侵入性，且术后ADL预计会显著低于术前水平。因此，我们使用开窗覆膜支架移植物从0区进行了去分支TEVAR。患者术后第11天出院。
对于传统手术可能不可行的体弱老年患者，TEVAR成为一种首选替代方案。然而，主动脉弓近端TAA的TEVAR仍然存在挑战，在干预策略中需要仔细关注颈部分支。虽然对这些患者进行手术干预需要仔细考虑其适用性，包括术后ADL改善的可能性，但使用0区开窗覆膜支架移植物是治疗方式之一。
作者介绍了一个非常老年的病例，其中使用开窗覆膜支架移植物避免了大型主动脉弓瘤的主动脉弓置换，术后病程良好，ADL没有下降。
