Radiofrequency In Situ Fenestration for Aortic Arch Vessels During Thoracic Endovascular Repair
Radiofrequency In Situ Fenestration for Aortic Arch Vessels During Thoracic Endovascular Repair
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DOI：
10.1177/1526602814565776
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发表时间：
2015-02-01
影响因子：
2.6
通讯作者：
Tan, Kong Teng
中科院分区：
文献类型：
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作者：
Tse, Leonard W.;Lindsay, Thomas F.;Tan, Kong Teng
目的：报告在胸主动脉腔内修复术（TEVAR）期间使用射频穿刺创建逆行原位开窗的新型技术的首次临床应用。研究方法：在2011年6月至2013年12月期间，在我们的机构进行了40例TEVAR手术，其中包括10例计划原位开窗的病例。展开了两种胸主动脉覆膜支架模型：Valiant（n=5）和Zenith TX 2（n=5）。从肱动脉入路输送的0.035英寸PowerWire射频导丝用于开窗覆盖9例左锁骨下动脉（LSA）和1例左颈总动脉的移植物。将开窗连续扩张至6 mm，并将自膨式Advanta V12覆膜支架定位在靶动脉中。结果：10例计划病例中有6例实现了技术成功。在其余4例病例中，2例病例的覆膜支架在3区展开（1例在LSA处植入烟囱）。另一枚覆膜支架在2区展开，放弃开窗后无内漏（LSA通过椎动脉充盈良好）。在最后一例病例中，双层（近端延伸重叠）覆膜支架的开窗术不成功;需要颈动脉-腋动脉旁路术。无开窗相关并发症，但总体手术并发症包括1例脊髓引流后消退的下肢轻瘫和1例因既存食管瘘死亡。无术后卒中。在平均12个月随访时（范围1-33），所有开窗均保持通畅，无内漏。结论：放射性穿刺是TEVAR期间原位开窗术中针或激光穿刺的可行替代方法。早期临床结果表明技术可行性和可接受的早期结局。
Purpose: To report the first clinical application of a novel technique using radiofrequency puncture to create retrograde in situ fenestrations during thoracic endovascular aortic repair (TEVAR). Methods: Between June 2011 and December 2013, 40 TEVAR procedures were performed in our facility, including 10 cases in which in situ fenestration was planned. Two thoracic stent-graft models were deployed: the Valiant (n=5) and the Zenith TX2 (n=5). A 0.035-inch PowerWire radiofrequency guidewire delivered from a brachial approach was used to fenestrate the grafts covering a left subclavian artery (LSA) in 9 cases and a left common carotid artery in one. The fenestrations were serially dilated to 6 mm, and self-expanding Advanta V12 covered stents were positioned in the target arteries. Results: Technical success was achieved in 6 of the 10 planned cases. Of the remaining 4 cases, stent-grafts were deployed in zone 3 in 2 cases (one received a chimney to the LSA). Another stent-graft was deployed in zone 2 without endoleak after fenestration was abandoned (the LSA had good filling via the vertebral artery). In the last case, the fenestration was unsuccessful in double-layered (proximal extension overlap) stent-grafts; a carotid-axillary bypass was required. There were no fenestration-related complications, but overall surgical complications included a case of paraparesis that resolved following spinal drainage and a death from a preexisting aortoesophageal fistula. There were no postoperative strokes. All fenestrations remained patent, and there were no endoleaks at a mean 12-month follow-up (range 1-33). Conclusion: Radiofrequency puncture is a viable alternative to needle or laser punctures for in situ fenestration during TEVAR. Early clinical results suggest technical feasibility and acceptable early outcomes.