PDF(Pubmed)
Abstract：
UNASSIGNED: Open surgery remains the gold standard technique for the treatment of aortic arch pathologies, although endovascular techniques offer a new opportunity for patients deemed unfit for open repair. This paper assesses the early outcomes of patients treated with a double inner-branched arch endograft in a single, tertiary-care institution.
UNASSIGNED: All consecutive cases of elective endovascular arch repair from 2016 to 2022 were included in a prospective database. All procedures were performed using the custom-made Relay® (Terumo Aortic-Bolton Medical Inc., Sunrise, FL, USA) double inner-branched endograft; an extra-anatomical bypass was associated in all cases to preserve the patency of supra-aortic trunks. Comorbidities, periprocedural data, immediate results and follow-up complications were analyzed.
UNASSIGNED: Twelve patients were treated during the study period [mean age 74±7 years, 100% male, 58% American Society of Anesthesiologists (ASA) risk ≥3]. Treated conditions included aneurysms (n=9), one pseudoaneurysm, one aortic ulcer and a type IA endoleak. The technical success rate was 100%. Early complications included respiratory insufficiency (n=3; 25%), stroke (n=1; 8.3%), acute coronary syndrome needing coronary stenting (n=1; 8.3%), and one perioperative death (n=1; 8.3%) secondary to an intracranial bleeding after coronary stenting. One patient required early reintervention due to retroperitoneal iliac access bleeding (n=1; 8.3%). During a median follow-up of 15.5 (range, 0-44) months, four patients suffered neurological events (two of them of cardioembolic origin), one reintervention was needed (subclavian anastomosis pseudoaneurysm), and a type IB endoleak was diagnosed. Overall mortality was of 17% (n=2), with an 83% overall survival at 2 years. The aortic-related death-free survival was 100%.
UNASSIGNED: Endovascular treatment of aortic arch pathology is feasible and shows promising early mortality and stroke rates in high-risk candidates. The main short and midterm goal should be minimizing neurological complications. A longer follow-up is mandatory to determine the effectiveness of the technique and to detect device related complications.
UNASSIGNED: All consecutive cases of elective endovascular arch repair from 2016 to 2022 were included in a prospective database. All procedures were performed using the custom-made Relay® (Terumo Aortic-Bolton Medical Inc., Sunrise, FL, USA) double inner-branched endograft; an extra-anatomical bypass was associated in all cases to preserve the patency of supra-aortic trunks. Comorbidities, periprocedural data, immediate results and follow-up complications were analyzed.
UNASSIGNED: Twelve patients were treated during the study period [mean age 74±7 years, 100% male, 58% American Society of Anesthesiologists (ASA) risk ≥3]. Treated conditions included aneurysms (n=9), one pseudoaneurysm, one aortic ulcer and a type IA endoleak. The technical success rate was 100%. Early complications included respiratory insufficiency (n=3; 25%), stroke (n=1; 8.3%), acute coronary syndrome needing coronary stenting (n=1; 8.3%), and one perioperative death (n=1; 8.3%) secondary to an intracranial bleeding after coronary stenting. One patient required early reintervention due to retroperitoneal iliac access bleeding (n=1; 8.3%). During a median follow-up of 15.5 (range, 0-44) months, four patients suffered neurological events (two of them of cardioembolic origin), one reintervention was needed (subclavian anastomosis pseudoaneurysm), and a type IB endoleak was diagnosed. Overall mortality was of 17% (n=2), with an 83% overall survival at 2 years. The aortic-related death-free survival was 100%.
UNASSIGNED: Endovascular treatment of aortic arch pathology is feasible and shows promising early mortality and stroke rates in high-risk candidates. The main short and midterm goal should be minimizing neurological complications. A longer follow-up is mandatory to determine the effectiveness of the technique and to detect device related complications.
摘要：
■开放手术仍然是治疗主动脉弓病变的金标准技术，尽管血管内技术为被认为不适合开放修复的患者提供了新的机会。本文评估了采用双内分支足弓内移植物治疗的患者的早期结果，三级护理机构。
■2016年至2022年的所有选择性腔内弓修复的连续病例均纳入前瞻性数据库。所有程序均使用定制的Relay®（TerumoAortic-BoltonMedicalInc.，日出,FL,USA）双内分支内移植物；在所有情况下，都与解剖外搭桥术相关，以保持主动脉上干的通畅。合并症,围手术期数据,分析即时结果和随访并发症。
■在研究期间接受了12例患者的治疗[平均年龄74±7岁，100%男性,58%的美国麻醉医师协会（ASA）风险≥3]。治疗条件包括动脉瘤（n=9），一个假性动脉瘤,1例主动脉溃疡和IA型内漏。技术成功率为100%。早期并发症包括呼吸功能不全（n=3；25%），中风(n=1；8.3%)，需要冠状动脉支架置入的急性冠状动脉综合征（n=1；8.3％），1例冠状动脉支架置入术后继发颅内出血的围手术期死亡(n=1;8.3%)。1例患者因腹膜后髂动脉出血需要早期再介入治疗（n=1；8.3%）。在中位随访15.5(范围，0-44）个月，四名患者发生了神经系统事件（其中两名是心脏栓塞），需要再次介入（锁骨下吻合假性动脉瘤），并诊断为IB型内漏。总死亡率为17%（n=2），2年总生存率为83%。主动脉相关的无死亡生存率为100%。
■主动脉弓病变的腔内治疗是可行的，并且在高危候选人中显示出有希望的早期死亡率和卒中发生率。主要的短期和中期目标应该是尽量减少神经系统并发症。必须进行更长的随访以确定该技术的有效性并检测与设备相关的并发症。
■2016年至2022年的所有选择性腔内弓修复的连续病例均纳入前瞻性数据库。所有程序均使用定制的Relay®（TerumoAortic-BoltonMedicalInc.，日出,FL,USA）双内分支内移植物；在所有情况下，都与解剖外搭桥术相关，以保持主动脉上干的通畅。合并症,围手术期数据,分析即时结果和随访并发症。
■在研究期间接受了12例患者的治疗[平均年龄74±7岁，100%男性,58%的美国麻醉医师协会（ASA）风险≥3]。治疗条件包括动脉瘤（n=9），一个假性动脉瘤,1例主动脉溃疡和IA型内漏。技术成功率为100%。早期并发症包括呼吸功能不全（n=3；25%），中风(n=1；8.3%)，需要冠状动脉支架置入的急性冠状动脉综合征（n=1；8.3％），1例冠状动脉支架置入术后继发颅内出血的围手术期死亡(n=1;8.3%)。1例患者因腹膜后髂动脉出血需要早期再介入治疗（n=1；8.3%）。在中位随访15.5(范围，0-44）个月，四名患者发生了神经系统事件（其中两名是心脏栓塞），需要再次介入（锁骨下吻合假性动脉瘤），并诊断为IB型内漏。总死亡率为17%（n=2），2年总生存率为83%。主动脉相关的无死亡生存率为100%。
■主动脉弓病变的腔内治疗是可行的，并且在高危候选人中显示出有希望的早期死亡率和卒中发生率。主要的短期和中期目标应该是尽量减少神经系统并发症。必须进行更长的随访以确定该技术的有效性并检测与设备相关的并发症。
