Chen Shihan, Li Xiaoye, Zhang Hao, Zhang Lei, Song Chao, Li Haiyan, Wei Minxin, Liu Zhao, Lu Qingsheng
Department of Vascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
Department of Cardiovascular Surgery, Hong Kong University Shenzhen Hospital, Shenzhen, China.
J Thorac Dis. 2024 Sep 30;16(9):6140-6149. doi: 10.21037/jtd-24-829. Epub 2024 Sep 26.
Thoracic endovascular aortic repair (TEVAR) with fenestrated surgeon-modified stent-grafts (f-SMSGs) is becoming an option for treating type B aortic dissection (TBAD) involving the aortic arch. This study aimed to evaluate the outcomes of this technique.
A retrospective multicenter study was conducted, involving consecutive patients from three medical centers in China who underwent TEVAR with f-SMSG for TBAD. A new technique called "Lu's direction-turnover technique" was employed to align the fenestrations with supra-aortic vessels.
From March 2016 to January 2020, 117 patients diagnosed with TBAD were deemed eligible for inclusion. The technical success rate was 94% (n=110). The estimated 30-day survival rate was 97.4% [95% confidence interval (CI): 94.5% to 100.0%], with freedom from re-intervention estimated at 95.7% (95% CI: 92.0% to 99.4%). The median follow-up period was 27 months (interquartile range, 19 to 35 months). The estimated survival rate at 27 months was 94.9% (95% CI: 90.8% to 98.9%) and the rate of freedom from re-intervention was 91.5% (95% CI: 86.3% to 96.6%). Cases of retrograde type A aortic dissection, stroke and endoleaks were documented. Five cases of retrograde type A aortic dissection were documented, with three occurring within 30 days and one during the follow-up. Four cases of stroke were recorded, with one occurring within 30 days and three during the follow-up. Furthermore, eleven cases of endoleaks were recorded, with one occurring within 30 days and ten during the follow-up.
Clinically acceptable technical success and prognosis were observed in a cohort with TEVAR with f-SMSG for the treatment of TBAD involving the aortic arch, which necessitated revascularization of the supra-aortic vessels. Further comparative studies are required to validate the benefits of this approach.
使用开窗式外科医生改良支架型人工血管（f-SMSG）进行胸主动脉腔内修复术（TEVAR）正成为治疗累及主动脉弓的B型主动脉夹层（TBAD）的一种选择。本研究旨在评估该技术的疗效。
进行了一项回顾性多中心研究，纳入了来自中国三个医疗中心连续接受f-SMSG治疗TBAD的患者。采用一种名为“卢氏转向技术”的新技术，使开窗与主动脉弓上血管对齐。
2016年3月至2020年1月，117例诊断为TBAD的患者被认为符合纳入标准。技术成功率为94%（n = 110）。估计30天生存率为97.4%[95%置信区间（CI）：94.5%至100.0%]，再次干预的自由度估计为95.7%（95%CI：92.0%至99.4%）。中位随访期为27个月（四分位间距，19至35个月）。27个月时的估计生存率为94.9%（95%CI：90.8%至98.9%），再次干预的自由度为91.5%（95%CI：86.3%至96.6%）。记录了逆行性A型主动脉夹层、中风和内漏的病例。记录了5例逆行性A型主动脉夹层，3例发生在30天内，1例发生在随访期间。记录了4例中风，1例发生在30天内，3例发生在随访期间。此外，记录了11例内漏，1例发生在30天内，10例发生在随访期间。
在一组使用f-SMSG进行TEVAR治疗累及主动脉弓的TBAD且需要对主动脉弓上血管进行血运重建的患者中，观察到了临床上可接受的技术成功率和预后。需要进一步的对照研究来验证这种方法的益处。
