Zhao Zihe, Han Yuexue, Keyoumu Reyaguli, Zhang Shuai, Gao Xia, Liu Zhao
Department of Vascular Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Jiangsu Provincial Key Medical Discipline (Laboratory), Department of Otolaryngology Head and Neck Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Front Cardiovasc Med. 2024 Nov 7;11:1496139. doi: 10.3389/fcvm.2024.1496139. eCollection 2024.
This study aims to improve fenestrated/branched endovascular aortic repair (F/B EVAR) through fabricating physician-modified stent grafts (PMSG) with short bridging stent to treat complex aortic dissection.
From November 2018 to January 2024, a total of 82 aortic dissection patients were treated by F/B EVAR combined with short bridging stents, including 19 aortic arch dissection patients and 63 thoracoabdominal aortic dissection patients. Inner or outer short bridging stents were applied to fabricate PMSG with the help of 3D-printing models intraoperatively. All patients underwent postoperative evaluation by enhanced computed tomography in follow-up.
All aortic dissections were successfully repaired. In aortic arch group, the average operative time was 289.2 ± 88.8 min. The perioperative mortality rate was 5.3%. The total reintervention rate was 5.3%. The average follow-up duration of 36.2 ± 9.5 months. The total incidence of endoleak after surgery was 15.8%. In thoracoabdominal aorta group, the average operative time was 345.5 ± 112.0 min. The perioperative mortality rate was 1.6%. The total reintervention rate was 1.6%. The average follow-up duration of 32.4 ± 19.2 months. The total incidence of endoleak after surgery was 11.1%.
The application of short bridging stents has shown promising results in reducing endoleak rates after F/B EVAR. 3D-printing is a feasible way to assist the precise fenestration and design of short bridging stents. However, the safety and reliability of this method need to be further validated.
本研究旨在通过制造带有短桥接支架的医生改良型覆膜支架（PMSG）来改善开窗/分支型血管腔内主动脉修复术（F/B EVAR），以治疗复杂主动脉夹层。
2018年11月至2024年1月，共有82例主动脉夹层患者接受了F/B EVAR联合短桥接支架治疗，其中包括19例主动脉弓夹层患者和63例胸腹主动脉夹层患者。术中借助3D打印模型应用内或外短桥接支架制造PMSG。所有患者术后随访均接受增强计算机断层扫描评估。
所有主动脉夹层均成功修复。在主动脉弓组，平均手术时间为289.2±88.8分钟。围手术期死亡率为5.3%。总再次干预率为5.3%。平均随访时间为36.2±9.5个月。术后内漏总发生率为15.8%。在胸腹主动脉组，平均手术时间为345.5±112.0分钟。围手术期死亡率为1.6%。总再次干预率为1.6%。平均随访时间为32.4±19.2个月。术后内漏总发生率为11.1%。
短桥接支架的应用在降低F/B EVAR术后内漏率方面显示出有前景的结果。3D打印是辅助短桥接支架精确开窗和设计的可行方法。然而，该方法的安全性和可靠性需要进一步验证。
