Vacirca Andrea, Faggioli Gianluca, Caputo Stefania, Di Leo Antonino, Gallitto Enrico, Gargiulo Mauro
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Vascular Surgery, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.
Eur J Vasc Endovasc Surg. 2025 May 13. doi: 10.1016/j.ejvs.2025.05.013.
Type B acute aortic syndrome (AAS) and thoracic or thoraco-abdominal aortic aneurysm (TAA/TAAA) requiring proximal sealing in Ishimaru zone 2 have traditionally been managed with thoracic endovascular aortic repair (T-EVAR), often combined with carotid subclavian bypass (CSB). The new Gore Thoracic Branch Endograft (TBE) facilitates the treatment of distal aortic arch lesions by including the left subclavian artery, yet maintaining its patency. This study aimed to assess the anatomical feasibility of TBE in patients treated or awaiting treatment for AAS or TAA/TAAA requiring proximal seal in zone 2.
This was a retrospective cohort analysis of all patients with AAS or TAA/TAAA referred to a single centre (January 2018 to March 2025) requiring proximal seal in zone 2 and with an indication for endovascular repair. Pre-operative computed tomography scans were reviewed. Anatomical feasibility (AF) was defined according to the TBE instructions for use. Iliac feasibility (IF) was determined based on iliofemoral diameters and calcification. True feasibility (TF) was the combination of AF and IF.
During the study period, 93 patients (78% male; median age at presentation 72 years [63,79]) were enrolled, of whom 65 (70%) had AAS and 28 (30%) had TAA/TAAA. T-EVAR with CSB was performed in 53% (49/93), T-EVAR with LSA coverage in 26% (24/93), and TBE in 5% (5/93); 16% (15/93) were awaiting endovascular repair. The overall AF for TBE was 92%, while TF was 85%, with seven patients showing hostile iliofemoral axes. There were no statistically significant differences in TBE AF (AAS 91% vs. TAA/TAAA 96%; p = .67) and TF (AAS 85% vs. TAA/TAAA 86%; p = 1.0) among patients with AAS and TAA/TAAA.
TBE showed high AF in both AAS and TAA/TAAAs requiring proximal sealing in zone 2. However, the elevated profile of the endograft may be considered a concern in patients with hostile iliofemoral axes.
传统上，需要在石丸2区进行近端封闭的B型急性主动脉综合征（AAS）和胸主动脉或胸腹主动脉瘤（TAA/TAAA）采用胸主动脉腔内修复术（T-EVAR）治疗，通常联合颈动脉-锁骨下动脉旁路移植术（CSB）。新型戈尔胸部分支型人工血管（TBE）通过纳入左锁骨下动脉并保持其通畅，便于治疗主动脉弓远端病变。本研究旨在评估TBE在因AAS或TAA/TAAA需要在2区进行近端封闭而接受治疗或等待治疗的患者中的解剖学可行性。
这是一项对所有转诊至单一中心（2018年1月至2025年3月）、需要在2区进行近端封闭且有腔内修复指征的AAS或TAA/TAAA患者的回顾性队列分析。回顾术前计算机断层扫描。解剖学可行性（AF）根据TBE使用说明进行定义。根据髂股直径和钙化情况确定髂部可行性（IF）。真正的可行性（TF）是AF和IF的综合。
在研究期间，共纳入93例患者（男性占78%；就诊时中位年龄72岁[63,79]），其中65例（70%）患有AAS，28例（30%）患有TAA/TAAA。53%（49/93）的患者接受了T-EVAR联合CSB治疗，26%（24/93）的患者接受了T-EVAR联合左锁骨下动脉覆盖治疗，5%（5/93）的患者接受了TBE治疗；16%（15/93）的患者等待腔内修复。TBE的总体AF为92%，而TF为85%，有7例患者髂股轴情况不佳。AAS和TAA/TAAA患者的TBE AF（AAS为91% vs. TAA/TAAA为96%；p = 0.67）和TF（AAS为85% vs. TAA/TAAA为86%；p = 1.0）无统计学显著差异。
TBE在需要在2区进行近端封闭的AAS和TAA/TAAA患者中均显示出较高的AF。然而，对于髂股轴情况不佳的患者，人工血管较高的外形可能是一个问题。
