Aru Roberto G, Porez Florent, LE Houérou Thomas, Palmier Mickael, Gaudin Antoine, Fabre Dominique, Haulon Stéphan
Aortic Center, Department of Cardiac and Vascular Surgery, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Paris, France.
Aortic Center, Department of Cardiac and Vascular Surgery, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Paris, France -
J Cardiovasc Surg (Torino). 2025 Jun;66(3):178-193. doi: 10.23736/S0021-9509.25.13325-9. Epub 2025 May 15.
The purpose of this study was to evaluate the outcomes of branched endovascular aortic repair (BEVAR) in post-dissection thoracoabdominal aortic aneurysms (PD TAAAs), as well as define preoperative planning and intraoperative execution.
Patients who underwent BEVAR in PD TAAAs from 2019 to 2024 were identified using a prospectively maintained electronic database at a single, tertiary-care hospital. Patient demographics, comorbidities, indication for the procedure, anatomic and procedural details, and outcomes were retrospectively recorded.
Thirty-four patients (74% male, median age 62 years) underwent BEVAR for PD TAAA. There was a high incidence of hypertension (79%) and stage III-V chronic kidney disease (41%). Prior aortic surgery was prevalent in the majority (62%) of patients, with an open (53%) and/or endovascular (35%) approach. BEVAR was commonly performed for asymptomatic PD-TAAA without rupture (71%). Target vessels (TV) arising from the false lumen (FL) and dissected TVs occurred in 32% and 11%, respectively. The majority underwent staged repair by an open (15%) and/or endovascular (47%) approach, most commonly zone 2 (24%) or 3 (15%) thoracic endovascular aortic repair (TEVAR). The off-the-shelf t-Branch (Cook Medical) was used in 24 (70%) patients. The proximal and distal landing zones were in prior/staged TEVAR (71%) and in native infrarenal aorta (65%), respectively. The bridging stent-graft was most commonly balloon-expandable (70%), including hybrid stenting with self-expandable stent-grafts. Adjunctive FL management and prophylactic embolization of type II endoleaks were performed in 56% and 79%, respectively. Technical success was 94%. Postoperative complications were most commonly self-limited acute kidney injury (9%); there was no episodes of spinal cord ischemia. There was a 30-day mortality of 6%. Thirty-day reinterventions were 3% (N.=4, 130 target vessels) for TV-related instability and 6% (N.=2, 34 patients) for FL perfusion. Based on a median follow-up of 18 months, primary and primary-assisted patency of the TV were 94% and 99%, respectively. Midterm reinterventions were 6% for TV-related instability and 35% for FL perfusion. There were no surgical conversions.
BEVAR can be performed with high technical success in PD TAAAs. However, secondary interventions for TV instability and continued FL perfusion are frequent; thus, close follow-up is mandatory.
本研究的目的是评估分支型血管腔内主动脉修复术（BEVAR）治疗夹层后胸腹主动脉瘤（PD TAAA）的疗效，并明确术前规划和术中操作。
使用一家三级医疗中心前瞻性维护的电子数据库，确定2019年至2024年期间接受BEVAR治疗PD TAAA的患者。回顾性记录患者的人口统计学资料、合并症、手术指征、解剖和手术细节以及治疗结果。
34例患者（74%为男性，中位年龄62岁）接受了BEVAR治疗PD TAAA。高血压（79%）和III - V期慢性肾病（41%）的发病率较高。大多数患者（62%）曾接受过主动脉手术，采用开放手术（53%）和/或血管腔内手术（35%）。BEVAR通常用于无症状的未破裂PD - TAAA（71%）。源于假腔（FL）的靶血管（TV）和夹层TV分别占32%和11%。大多数患者通过开放手术（15%）和/或血管腔内手术（47%）进行分期修复，最常见的是2区（24%）或3区（15%）的胸段血管腔内主动脉修复术（TEVAR）。24例（70%）患者使用了现成的t型分支（库克医疗公司）。近端和远端锚定区分别位于先前/分期的TEVAR（71%）和肾下腹主动脉（65%）。桥接支架移植物最常见的是球囊扩张型（70%），包括与自膨式支架移植物的混合支架置入。分别有56%和79%的患者进行了辅助性FL处理和II型内漏的预防性栓塞。技术成功率为94%。术后并发症最常见的是自限性急性肾损伤（9%）；未发生脊髓缺血事件。30天死亡率为6%。30天再次干预中，因TV相关不稳定的发生率为3%（N = 4，130条靶血管），因FL灌注的发生率为6%（N = 2，34例患者）。基于18个月的中位随访，TV的一期通畅率和一期辅助通畅率分别为94%和99%。中期再次干预中，因TV相关不稳定的发生率为6%，因FL灌注的发生率为35%。无手术中转情况。
BEVAR治疗PD TAAA的技术成功率较高。然而，TV不稳定和FL持续灌注的二次干预较为频繁；因此，密切随访是必要的。
