Takahashi Yosuke, Morisaki Akimasa, Nishiya Kenta, Inno Gouki, Kawase Takumi, Nishimoto Yukihiro, Nagao Munehide, Noda Kazuki, Nangoya Ryo, Shibata Toshihiko
Department of Cardiovascular Surgery, Osaka Metropolitan University Postgraduate School of Medicine, Osaka, Japan.
J Thorac Dis. 2024 Oct 31;16(10):6525-6536. doi: 10.21037/jtd-24-1169. Epub 2024 Oct 30.
Changes in stent graft (SG) orientation after frozen elephant trunk (FET) treatment for aortic arch aneurysms are not well understood. This study investigated changes in SG orientation and their effects on aortic events after FET for aortic arch aneurysms.
This study included 57 patients with true aneurysms who underwent elective total arch replacement using FET between 2016 and 2023. Postoperative SG angle, descending aortic (DA) diameter at the end of the SG, and the DA angle were measured retrospectively by using enhanced computed tomography (CT).
Median patient age was 74 years. The median stent size was 33 mm, and the stent length was 12 cm (range, 23-37 mm and 6-15 cm). Enhanced CT showed that all the patients had completely thrombosed aneurysms after the procedure. Aortic events (dissection or type Ib leaks) were observed in four patients during the follow-up period. The diameter of the DA at the end of the SG and the DA angle increased in recent periods (P=0.04 and P=0.01, respectively). The SG angle changed to an obtuse angle in the recent periods (P<0.0001). The probability of postoperative aortic events did not correlate with changes in SG orientation but with the ratio of recent postoperative descending diameter to preoperative descending diameter (P=0.04).
The descending aorta into which the SG was inserted showed flattening and widening movements owing to the spiring back force. One of the factors related to aortic events was dilation of the postoperative DA due to oversizing of the SG.
对于主动脉弓动脉瘤采用冰冻象鼻技术（FET）治疗后，支架型人工血管（SG）的方向变化尚未完全明确。本研究调查了FET治疗主动脉弓动脉瘤后SG方向的变化及其对主动脉相关事件的影响。
本研究纳入了57例真性动脉瘤患者，这些患者在2016年至2023年间接受了择期全弓置换术并使用了FET。通过增强计算机断层扫描（CT）对术后SG角度、SG末端降主动脉（DA）直径以及DA角度进行回顾性测量。
患者中位年龄为74岁。支架中位尺寸为33mm，支架长度为12cm（范围为23 - 37mm和6 - 15cm）。增强CT显示所有患者术后动脉瘤均完全血栓形成。随访期间有4例患者发生主动脉相关事件（夹层或Ib型内漏）。近期SG末端的DA直径和DA角度均增加（分别为P = 0.04和P = 0.01）。近期SG角度变为钝角（P < 0.0001）。术后主动脉相关事件的发生概率与SG方向的变化无关，而是与术后近期降主动脉直径与术前降主动脉直径的比值相关（P = 0.04）。
由于回缩力，SG置入的降主动脉呈现变平和增宽的运动。与主动脉相关事件相关的因素之一是SG尺寸过大导致术后DA扩张。
