Abstract：
BACKGROUND: The objective of this case series is to investigate the outcomes of double-fenestrated physician-modified endografts (PMEGs) in patients with distal anastomotic aneurysms after open repair of the ascending aorta or proximal arch replacement.
METHODS: All consecutive patients with a distal anastomotic aneurysm after open ascending aorta surgery who underwent aortic arch repair with a homemade double-fenestrated stent-graft from 2017 to 2023 were reviewed. Study endpoints included technical success, 30-day, and long-term follow up analysis of mortality, morbidity, and reinterventions.
RESULTS: 10 patients were treated with double-fenestrated PMEGs for anastomotic aneurysms after open surgery of the ascending aorta. Of these, 9 were male with a mean age of 58 years. Nine patients were initially treated for acute dissection, and 2 had mechanical aortic valves. The mean time between open surgery and the treatment of the pseudoaneurysm was 4.15 years. Technical success was 100%. The proximal landing zone was consistently in zone 0, and all endografts were deployed via femoral access. Early outcomes revealed one endoleak (type 1a), which was successfully treated by prompt reintervention. No deaths or strokes occurred during the early postoperative period. During long-term follow up (mean time 35 months), no endoleaks requiring intervention occurred, and there were no reports of stent fractures or migrations. No patient died from an aortic-related cause.
CONCLUSIONS: Aortic arch repair with double-fenestrated PMEGs for distal anastomotic aneurysms after open surgery is feasible and represents a promising alternative in patients ineligible for redo surgery.
METHODS: All consecutive patients with a distal anastomotic aneurysm after open ascending aorta surgery who underwent aortic arch repair with a homemade double-fenestrated stent-graft from 2017 to 2023 were reviewed. Study endpoints included technical success, 30-day, and long-term follow up analysis of mortality, morbidity, and reinterventions.
RESULTS: 10 patients were treated with double-fenestrated PMEGs for anastomotic aneurysms after open surgery of the ascending aorta. Of these, 9 were male with a mean age of 58 years. Nine patients were initially treated for acute dissection, and 2 had mechanical aortic valves. The mean time between open surgery and the treatment of the pseudoaneurysm was 4.15 years. Technical success was 100%. The proximal landing zone was consistently in zone 0, and all endografts were deployed via femoral access. Early outcomes revealed one endoleak (type 1a), which was successfully treated by prompt reintervention. No deaths or strokes occurred during the early postoperative period. During long-term follow up (mean time 35 months), no endoleaks requiring intervention occurred, and there were no reports of stent fractures or migrations. No patient died from an aortic-related cause.
CONCLUSIONS: Aortic arch repair with double-fenestrated PMEGs for distal anastomotic aneurysms after open surgery is feasible and represents a promising alternative in patients ineligible for redo surgery.
摘要：
目的：本系列病例的目的是探讨双开窗内科医生改良内移植物（PMEGs）对远端吻合动脉瘤患者在升主动脉开放修复或近端弓置换后的疗效。
方法：回顾了2017年至2023年所有连续的开放性升主动脉手术后远端吻合动脉瘤的患者，这些患者使用自制的双开窗支架进行了主动脉弓修复。研究终点包括技术成功，30天,和死亡率的长期随访分析，发病率，重新干预。
结果：10例患者在升主动脉开放手术后接受双开窗PMEGs治疗吻合动脉瘤。其中,9人为男性，平均年龄58岁。9名患者最初接受急性夹层治疗，两个有机械主动脉瓣。开放手术与假性动脉瘤治疗之间的平均时间为4.15年。技术成功100%。近端着陆区始终位于0区，所有内移植物均通过股骨入路展开。早期结果显示一个内漏（1a型），通过及时重新干预成功治疗。术后早期无死亡或中风发生。在长期随访期间（平均时间35个月），没有发生需要干预的内漏，没有支架骨折或迁移的报告。没有患者死于主动脉相关原因。
结论：对于开放手术后的远端吻合动脉瘤，采用双开窗的PMEG进行主动脉弓修复是可行的，并且对于不适合进行重做手术的患者是一种有希望的替代方法。
方法：回顾了2017年至2023年所有连续的开放性升主动脉手术后远端吻合动脉瘤的患者，这些患者使用自制的双开窗支架进行了主动脉弓修复。研究终点包括技术成功，30天,和死亡率的长期随访分析，发病率，重新干预。
结果：10例患者在升主动脉开放手术后接受双开窗PMEGs治疗吻合动脉瘤。其中,9人为男性，平均年龄58岁。9名患者最初接受急性夹层治疗，两个有机械主动脉瓣。开放手术与假性动脉瘤治疗之间的平均时间为4.15年。技术成功100%。近端着陆区始终位于0区，所有内移植物均通过股骨入路展开。早期结果显示一个内漏（1a型），通过及时重新干预成功治疗。术后早期无死亡或中风发生。在长期随访期间（平均时间35个月），没有发生需要干预的内漏，没有支架骨折或迁移的报告。没有患者死于主动脉相关原因。
结论：对于开放手术后的远端吻合动脉瘤，采用双开窗的PMEG进行主动脉弓修复是可行的，并且对于不适合进行重做手术的患者是一种有希望的替代方法。
