■电外科长期以来一直用于血管内手术,只有主动脉区域的病例报告。我们的目的是提供一个病例系列,该病例系列使用电气化导线通过电烙笔施加外部电流来执行基于导管的电外科手术。
■从2020年10月至2023年8月接受复杂主动脉手术的所有患者的单中心回顾性病例系列,其中使用了电气化线技术:(1)夹层皮瓣穿孔或左锁骨下动脉(LSA)原位内移植物开窗-0.014“聚四氟乙烯(PTFE)绝缘导丝在末端用手术刀从绝缘层上脱离,并在此处附有笔夹。将弯曲的尖端导管或鞘管放置在主动脉瓣或内移植物上(在这种情况下通过左臂通道),并推动导线,在与上述相同的准备之后,通过激活电烙笔穿过皮瓣,(2)切片解剖皮瓣(“电动奶酪丝技术”),0.014导丝的中间部分从PTFE移除并弯曲成V形。一旦进入主动脉,导丝从真腔(TL)穿过到假腔(FL),并且获得贯通通路。护套从两侧抵靠襟翼放置,并在通电时上下移动,切开襟翼并连通两个管腔。评估技术成功和技术相关并发症。
■治疗主动脉夹层11例,主动脉闭锁1例。四名病人紧急就诊,而其余的是计划好的程序。7例解剖皮瓣穿孔,2例接受了电动奶酪丝技术,在2例LSA原位开窗术中,1例发生主动脉峡部主动脉闭锁。该技术在所有情况下都成功应用。无相关并发症发生。
■\“电气化导线\”技术是一种可行且现成的工具,可安全地用于复杂的主动脉介入治疗,尤其是在主动脉组织上穿孔,如解剖皮瓣或通过内移植织物穿孔进行原位开窗修复。
结论:本文描述的电气化线技术是使用容易获得的工具来执行电外科手术的直接技术。我们介绍了其在复杂主动脉手术中的用途。然而,可以设想任何需要穿过血管或甚至假体材料的血管手术。正如我们在本系列中所描述的,当与适当的规划一起使用时,它可以是一个非常实用的安全工具,正如在介入心脏病学领域已经开始的那样。
UNASSIGNED: Electrosurgery has been long used in endovascular procedures, with only case reports in the aortic field. Our aim is to present a case series with the use of an electrified wire to perform catheter-based electrosurgery by applying external current through an electrocautery pen.
UNASSIGNED: Single-center retrospective case series of all patients undergoing complex aortic surgery from October 2020 to August 2023, in whom the electrified wire technique was used: (1) Perforation of a dissection flap or left subclavian artery (LSA) in situ endograft fenestration-a 0.014\" polytetrafluoroethylene (PTFE) insulated guidewire is detached from the insulation with a scalpel at the end and a cautery pen is here attached with a clamp. A curved tip catheter or sheath is positioned against the aortic flap or the endograft (through a left brachial access in this case) and the wire pushed, crossing the flap by activating the electrocautery pen and (2) slicing a dissection flap (\"powered cheese-wire technique\")-after same preparation as above, the middle section of the 0.014 guidewire is removed from the PTFE and bent into a V-shape. Once in the aorta, the guidewire crosses from the true lumen (TL) to the false lumen (FL) and a through-and-through access is obtained. Sheaths are positioned against the flap from both sides and moved up or down while the electricity is activated, slicing the flap and communicating both lumens. Technical success and technical-related complications were evaluated.
UNASSIGNED: Eleven cases concerning aortic dissections and 1 case of aortic atresia were treated. Four patients presented urgently, whereas the rest were planned procedures. Seven cases underwent perforation of a dissection flap, 2 cases underwent the powered cheese-wire technique, in 2 cases for an LSA in situ fenestration, and in 1 case to cross an aortic atresia at the aortic isthmus. The technique was in all cases successfully applied. No complications related to the technique occurred.
UNASSIGNED: The \"electrified wire\" technique is a feasible and ready-available tool that can be safely used in complex aortic interventions, especially to perforate aortic tissue like dissection flaps or to perform in situ fenestrated repairs by perforation of the endograft fabric.
CONCLUSIONS: The electrified wire technique described herein is a straightforward technique that uses readily available tools to perform electrosurgery. We present its use in complex aortic procedures. However, it could be envisioned for any vascular procedure that requires crossing of the vessel or even prosthetic material. As we have described in this series, when used along with an adequate properative planning, it can be a safe tool of great utility, as has already been demonstarted in the field of the interventional cardiology.