Endicott Kendal M, Pambianchi Hannah, Spinosa David, Ryan Liam
Division of Vascular Surgery, Inova Heart and Vascular Institute, Inova Health Systems, Falls Church, Virginia.
University of Virginia School of Medicine, Inova Heart and Vascular Institute, Inova Health Systems, Falls Church, Virginia.
Ann Thorac Surg Short Rep. 2024 Jul 15;2(4):712-717. doi: 10.1016/j.atssr.2024.06.025. eCollection 2024 Dec.
DeBakey type I aortic dissections (AD) are most frequently treated with hemiarch repair. A subset of patients demonstrates persistent distal end-organ ischemia secondary to persistent true lumen (TL) compression. We describe the use of bare metal stent grafting across the residual arch dissection with the Zenith Dissection Endovascular Stent (ZDES, Cook Medical) in 7 patients with type I AD that was repaired in a hemiarch configuration with a compromised distal TL and organ malperfusion.
Seven patients underwent ZDES placement from a hemiarch repair across the arch with extension to the aortic bifurcation in the acute and subacute phases. Pressure gradients between the ascending aorta and the femoral access were recorded. Preprocedure and postprocedure computed tomographic images were analyzed using centerline reconstruction. TL and false lumen areas were calculated on the basis of manually performed measurements on 8 points along the aorta.
All 7 cases were technically successful, without evidence of perioperative stroke or intraoperative death. There was a statistically significant increase in median TL area at all locations except 1 cm above the aortic bifurcation ( <.05). Pressure gradients between the ascending aorta and the femoral access in measured cases improved after stenting.
Bare metal stenting across the aortic arch after hemiarch repair in the setting of persistent distal TL compression is a technically viable strategy and may promote long-term aortic remodeling. This treatment strategy may represent another option for treatment of type I AD in patients presenting with distal malperfusion.
DeBakey I型主动脉夹层（AD）最常采用半弓修复治疗。一部分患者会因真腔（TL）持续受压而出现持续性远端终末器官缺血。我们描述了在7例I型AD患者中使用Zenith夹层腔内支架（ZDES，库克医疗公司）跨残余主动脉弓夹层植入裸金属支架的情况，这些患者采用半弓结构修复，远端TL受损且存在器官灌注不良。
7例患者在急性期和亚急性期接受了从半弓修复处跨主动脉弓至主动脉分叉处的ZDES植入。记录升主动脉与股动脉穿刺点之间的压力梯度。使用中心线重建分析术前和术后的计算机断层扫描图像。基于沿主动脉手动测量的8个点计算TL和假腔面积。
所有7例手术均技术成功，无围手术期卒中或术中死亡的证据。除主动脉分叉上方1 cm处外，所有部位的TL中位数面积均有统计学显著增加（<.05）。测量病例中，支架置入后升主动脉与股动脉穿刺点之间的压力梯度有所改善。
在持续性远端TL受压的情况下，半弓修复后跨主动脉弓植入裸金属支架是一种技术可行的策略，可能促进主动脉的长期重塑。这种治疗策略可能为出现远端灌注不良的I型AD患者提供另一种治疗选择。
