Outcomes after false lumen embolization with covered stent devices in chronic dissection
Outcomes after false lumen embolization with covered stent devices in chronic dissection
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DOI：
10.1016/j.jvs.2014.08.094
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发表时间：
2014-12-01
影响因子：
4.3
通讯作者：
Lytle, Bruce W.
中科院分区：
文献类型：
--
作者：
Idrees, Jahanzaib;Roselli, Eric E.;Lytle, Bruce W.
目的：持续性逆行假腔灌注是胸主动脉腔内修复术（TEVAR）治疗慢性夹层后的常见失败模式。目的是描述一种新的血管内假腔闭塞方法，并评估outcomes.Methods：从2009年到2013年，21例慢性胸腹夹层患者（平均年龄64 ± 11岁）使用覆膜支架器械进行持续逆行灌注，进行连续性假腔栓塞。8例患者存在B型夹层，13例患者在既往A型修复后存在残留夹层，所有患者均被视为开放手术的高风险。17例患者的假腔栓塞是初始TEVAR或扩展时的辅助手段，包括2例象鼻完成。在其他4例中，这是作为一个孤立的程序进行的，3例先前接受了保留腹腔动脉的TEVAR。覆膜支架器械包括18例髂动脉栓塞、2例镍钛合金栓塞和1例闭塞覆膜支架。结果：有一个医院死亡，由于左锁骨下动脉瘤破裂，但没有病人中风，截瘫，心肌梗死，或肾功能衰竭。平均随访时间为25 +/- 19个月。在监测计算机断层扫描成像，假腔血栓形成注意到在所有患者中，但4个需要进一步栓塞，因为血栓形成是不完全的。平均最大主动脉直径从64 +/- 14下降到59 +/- 15 mm. There是一个颅内出血晚期死亡，没有主动脉rupture.Conclusions：辅助假腔栓塞与覆膜支架装置促进血栓形成和重建后，支架移植的真腔慢性夹层。对这一战略的进一步研究是必要的。
Objective: Persistent retrograde false lumen perfusion is a common mode of failure after thoracic endovascular aortic repair (TEVAR) for chronic dissection. Objectives were to describe a novel endovascular approach for false lumen occlusion and assess outcomes.Methods: From 2009 to 2013, 21 patients (mean age, 64 +/- 11 years) with chronic thoracoabdominal dissection underwent adjunctive false lumen embolization using covered stent devices for persistent retrograde perfusion. Eight patients had type B dissection, 13 had residual dissection after prior type A repair, and all were deemed high risk for open operation. False lumen embolization in 17 patients was an adjunct at the initial TEVAR or extension, including two as elephant trunk completion. In the other four, this was done as an isolated procedure, and three had previously undergone TEVAR sparing the celiac artery. Covered stent devices included iliac plugs in 18, nitinol embolization plugs in two, and occluded stent graft in one. More than one device was used in 15 patients.Results: There was one hospital death due to left subclavian artery aneurysm rupture but no patient had stroke, paraplegia, myocardial infarction, or renal failure. Mean follow-up was 25 +/- 19 months. During surveillance computed tomography imaging, false lumen thrombosis was noted in all patients, but four required further embolization because the thrombosis was incomplete. Mean maximum aortic diameter decreased from 64 +/- 14 to 59 +/- 15 mm. There was one late death from intracranial hemorrhage and no aortic ruptures.Conclusions: Adjunctive false lumen embolization with a covered stent device promotes thrombosis and remodeling after stent grafting the true lumen for chronic dissection. Further study of this strategy is warranted.