Gao Xiaotian, Li Xin, Liu Shandong, Yu Chunhui
Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Hefei, 230022, Anhui Province, China.
J Cardiothorac Surg. 2025 May 27;20(1):239. doi: 10.1186/s13019-025-03469-9.
To share the results of the debranching technique with zone 1 thoracic endovascular aortic repair (TEVAR) in high-risk patients chosen based on older age, cardiopulmonary comorbidities, and unfit for open surgical procedures, who have distal arch lesions.
Between January 2020 and August 2022, 15 patients treated in our practice were treated with the debranching technique TEVAR (d-TEVAR) for distal aortic arch lesions requiring a stent-graft landing in zone 1. We retrospectively reviewed clinical data and significant outcomes for prognostic analyses. Lesion types included chronic Stanford type B aortic dissections (n = 10), distal arch aneurysms (n = 4), and one pseudoaneurysm. All lesions were chronic, with no involvement of visceral vessels. These patients were considered high-risk in a multidisciplinary fashion.
All procedures were completed with a technical success rate of 100%. The mean operative time was 317 ± 48 min. No in-hospital mortality or major complications were recorded. One patient had a type I endoleak at 3 months that was treated conservatively due to no symptoms during follow-up (median 16 months, (range 12-20)), and in one patient, this was associated with fatal cerebral infarction at 4 months following the procedure, yielding a stroke rate of 6.7%. Graft survival for all patients, via a Kaplan-Meier analysis, was 89.3%.
For distal aortic arch lesions requiring a zone 1 stent-graft landing, d-TEVAR is an effective and safe alternative treatment option with promising short-term results in well-selected high-risk patients and can be applied when open surgery constitutes a significant surgical risk.
分享针对基于高龄、心肺合并症且不适合开放手术的高危患者，采用去分支技术进行1区胸主动脉腔内修复术（TEVAR）治疗远端主动脉弓病变的结果。
2020年1月至2022年8月期间，我们对15例在我院接受治疗的患者采用去分支技术TEVAR（d-TEVAR）治疗需要在1区植入支架移植物的远端主动脉弓病变。我们回顾性分析临床数据和重要结果以进行预后分析。病变类型包括慢性B型主动脉夹层（n = 10）、远端主动脉弓瘤（n = 4）和1例假性动脉瘤。所有病变均为慢性，不累及内脏血管。这些患者经多学科评估被视为高危患者。
所有手术均成功完成，技术成功率为100%。平均手术时间为317±48分钟。未记录到院内死亡或重大并发症。1例患者在3个月时出现I型内漏，由于随访期间无症状（中位时间16个月，范围12 - 20个月）而接受保守治疗，1例患者在术后4个月发生致命性脑梗死，卒中发生率为6.7%。通过Kaplan-Meier分析，所有患者的移植物生存率为89.3%。
对于需要在1区植入支架移植物的远端主动脉弓病变，d-TEVAR是一种有效且安全的替代治疗选择，在精心挑选的高危患者中具有良好的短期效果，当开放手术存在重大手术风险时可应用。
