PDF(Pubmed)
Abstract：
UNASSIGNED: Aortic arch pathologies are serious clinical conditions associated with a very dismal prognosis. Traditional open surgery has a high mortality and is not suitable for critically ill patients. Recently years, endovascular treatment of thoracic aorta has made rapid progress and has been gradually applied to the treatment of aortic arch pathologies. However, maintaining cerebral blood flow during endovascular treatment of aortic arch lesions remains a challenge at this time. This study aims to evaluate the feasibility, efficacy, and safety of endovascular treatment of thoracic aortic pathologies involving the aortic arch, and to present initial experience with this technique.
UNASSIGNED: From October 2016 to December 2020, patients who met the inclusion criteria were enrolled. All patients underwent thoracic endovascular aortic repair with the proximal landing zone of the stent-graft in the aortic arch at Ishimaru zones 0-1, in which cerebral flow needs to be maintained during surgery, and the supra-aortic branches were reconstruction with either in situ fenestration or the chimney technique.
UNASSIGNED: A total of 62 cases with lesions involving the arch were treated with endovascular surgery. Total supra-aortic branches reconstruction was successfully performed in 51 cases, the left carotid artery (LCA) and the innominate artery reconstruction were performed in eight cases, the left subclavian artery (LSA) and the LCA were reconstructed in three patients. Among them, the in situ fenestration or chimney repair technique for the LSA was successful performed in 42 and 12 cases. However, in 20 patients, attempts to reconstruction the LSA using the fenestration technique were unsuccessful due to tortuous and angulated vessels. Early mortality was 6.45%. No neurological complications related to surgery occurred. Computer tomography images at post-operative follow-up (mean 3.51 months) confirmed patency of all branch stents without any signs of endoleaks, migration, conversion to retrograde dissection or receive open-heart surgery.
UNASSIGNED: The endovascular technique is an effective, feasible, safe and repeatable method to reconstruct the aortic arch, which allows for the reconstruction of the supra-aortic branches.
UNASSIGNED: From October 2016 to December 2020, patients who met the inclusion criteria were enrolled. All patients underwent thoracic endovascular aortic repair with the proximal landing zone of the stent-graft in the aortic arch at Ishimaru zones 0-1, in which cerebral flow needs to be maintained during surgery, and the supra-aortic branches were reconstruction with either in situ fenestration or the chimney technique.
UNASSIGNED: A total of 62 cases with lesions involving the arch were treated with endovascular surgery. Total supra-aortic branches reconstruction was successfully performed in 51 cases, the left carotid artery (LCA) and the innominate artery reconstruction were performed in eight cases, the left subclavian artery (LSA) and the LCA were reconstructed in three patients. Among them, the in situ fenestration or chimney repair technique for the LSA was successful performed in 42 and 12 cases. However, in 20 patients, attempts to reconstruction the LSA using the fenestration technique were unsuccessful due to tortuous and angulated vessels. Early mortality was 6.45%. No neurological complications related to surgery occurred. Computer tomography images at post-operative follow-up (mean 3.51 months) confirmed patency of all branch stents without any signs of endoleaks, migration, conversion to retrograde dissection or receive open-heart surgery.
UNASSIGNED: The endovascular technique is an effective, feasible, safe and repeatable method to reconstruct the aortic arch, which allows for the reconstruction of the supra-aortic branches.
摘要：
■主动脉弓病变是与非常糟糕的预后相关的严重临床病症。传统的开放手术死亡率高，不适用于危重病人。最近几年,胸主动脉腔内治疗取得了较快的进展,并逐步应用于主动脉弓病变的治疗。然而,目前，在主动脉弓病变的血管内治疗期间维持脑血流仍然是一个挑战。本研究旨在评估其可行性，功效,涉及主动脉弓的胸主动脉病变的血管内治疗的安全性，并介绍这种技术的初步经验。
■从2016年10月至2020年12月，纳入符合纳入标准的患者。所有患者均接受胸主动脉腔内修复术，支架移植物近端着陆区位于主动脉弓0-1区，手术期间需要维持脑血流，采用原位开窗术或烟囱技术重建主动脉上分支。
■共62例累及足弓的病变行血管内手术治疗。51例全主动脉上分支重建术成功,行左颈动脉(LCA)和无名动脉重建术8例,对3例患者进行左锁骨下动脉(LSA)和LCA重建。其中,42例和12例LSA的原位开窗或烟囱修复技术成功完成。然而,在20名患者中，由于血管弯曲和成角度,使用开窗技术重建LSA的尝试未成功.早期死亡率为6.45%。无手术相关神经系统并发症发生。术后随访（平均3.51个月）的计算机断层扫描图像证实所有分支支架通畅，没有任何内漏迹象。迁移,转换为逆行解剖或接受心脏直视手术。
■血管内技术是一种有效的，可行,安全和可重复的方法来重建主动脉弓，这允许重建主动脉上分支。
■从2016年10月至2020年12月，纳入符合纳入标准的患者。所有患者均接受胸主动脉腔内修复术，支架移植物近端着陆区位于主动脉弓0-1区，手术期间需要维持脑血流，采用原位开窗术或烟囱技术重建主动脉上分支。
■共62例累及足弓的病变行血管内手术治疗。51例全主动脉上分支重建术成功,行左颈动脉(LCA)和无名动脉重建术8例,对3例患者进行左锁骨下动脉(LSA)和LCA重建。其中,42例和12例LSA的原位开窗或烟囱修复技术成功完成。然而,在20名患者中，由于血管弯曲和成角度,使用开窗技术重建LSA的尝试未成功.早期死亡率为6.45%。无手术相关神经系统并发症发生。术后随访（平均3.51个月）的计算机断层扫描图像证实所有分支支架通畅，没有任何内漏迹象。迁移,转换为逆行解剖或接受心脏直视手术。
■血管内技术是一种有效的，可行,安全和可重复的方法来重建主动脉弓，这允许重建主动脉上分支。
