Iwakoshi Shinichi, Sakaguchi Shoji, Murata Mai, Nagata Tomoki, Tanaka Akimitsu, Kametani Ryosuke, Kameda Arisa, Maeda Shinsaku, Sato Takeshi, Nishiofuku Hideyuki, Ichihashi Shigeo, Tanaka Toshihiro, Kichikawa Kimihiko
Department of Diagnostic and Interventional Radiology, Nara Medical University, Japan.
Department of Radiology, Matsubara Tokusyukai Hospital, Japan.
Interv Radiol (Higashimatsuyama). 2024 Jun 3;9(2):49-54. doi: 10.22575/interventionalradiology.2022-0022. eCollection 2024 Jul 1.
During thoracic endovascular aortic repair for complicated Stanford type B aortic dissection, large bare stent placement for the abdominal aorta is sometimes necessary. In smaller abdominal aortic diameter cases, we used the stripped AFX aortic cuff as a scaffolding bare stent rather than the Zenith Dissection Endovascular Stent, which is a commercially available, large bare stent. In this study, we evaluated the feasibility of the stripped AFX aortic cuff and experiments were conducted to compare the stripped AFX and the Zenith Dissection Endovascular Stent.
The type B aortic dissection patients treated with thoracic endovascular aortic repair using stripped AFX at three institutions between January 2014 and December 2017 were retrospectively reviewed. Clinical data, including technical success, perioperative complication, and overall survival, were evaluated. The experiment assessed the chronic outward force that reflected the load acting on the artery wall from the stent.
Eight cases (seven males) were reviewed. The median (interquartile range, IQR) age of the patients was 60 years (46.3-70.3). The technical success rate was 100%, and no perioperative complications were observed. The median (IQR) follow-up period was 28.9 months (17.5-31.5). During the follow-up, one patient died of septic shock unrelated to aortic events. The median (IQR) diameter of the stripped AFX on the last follow-up CT was 23.5 mm (21.9-25.0). The chronic outward force of the Zenith Dissection Endovascular Stent was two to three times that of the stripped AFX.
The stripped AFX aortic cuff is feasible and safe as a scaffolding stent during thoracic endovascular aortic repair for Stanford Type B aortic dissection.
在复杂的斯坦福B型主动脉夹层的胸主动脉腔内修复术中，有时需要在腹主动脉放置大型裸支架。对于腹主动脉直径较小的病例，我们使用剥脱式AFX主动脉套作为支架裸支架，而不是使用市售的大型裸支架——天顶夹层腔内支架。在本研究中，我们评估了剥脱式AFX主动脉套的可行性，并进行实验比较剥脱式AFX和天顶夹层腔内支架。
回顾性分析2014年1月至2017年12月在三家机构接受使用剥脱式AFX进行胸主动脉腔内修复术治疗的B型主动脉夹层患者。评估临床数据，包括技术成功率、围手术期并发症和总生存率。该实验评估了反映支架作用于动脉壁的负荷的慢性外向力。
共回顾了8例患者（7例男性）。患者的年龄中位数（四分位间距，IQR）为60岁（46.3 - 70.3）。技术成功率为100%，未观察到围手术期并发症。随访期中位数（IQR）为28.9个月（17.5 - 31.5）。随访期间，1例患者死于与主动脉事件无关的感染性休克。最后一次随访CT上剥脱式AFX的直径中位数（IQR）为23.5 mm（21.9 - 25.0）。天顶夹层腔内支架的慢性外向力是剥脱式AFX的两到三倍。
在斯坦福B型主动脉夹层的胸主动脉腔内修复术中，剥脱式AFX主动脉套作为支架裸支架是可行且安全的。
