"Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results
"Hybrid" Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results
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DOI：
10.1016/j.athoracsur.2009.07.027
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发表时间：
2009-12-01
影响因子：
4.6
通讯作者：
McCann, Richard L.
中科院分区：
文献类型：
--
作者：
Hughes, G. Chad;Daneshmand, Mani A.;McCann, Richard L.
背景横主动脉弓的动脉瘤，特别是涉及中段至远端主动脉弓的动脉瘤，采用传统开放技术进行修复在技术上具有挑战性。我们提出了我们的结果与开放/血管内的方法（“混合修复”）在这样的患者。从2005年8月11日至2008年9月18日，28例患者接受了混合弓修复术。对于患有远端弓状动脉瘤但无名动脉远端近端锚定区（PLZ）≥ 2 cm的患者（n = 9），进行了右至左颈动脉-颈动脉旁路术，通过覆盖左侧颈动脉起源来创建PLZ。对于患有中段动脉瘤但升主动脉PLZ ≥ 2 cm的患者（n = 12），进行了基于近端升主动脉的动脉弓脱支术。对于没有足够PLZ（“巨型主动脉”）但有足够远端着陆区的弓状动脉瘤患者（n = 7），进行第一阶段象鼻手术以创建PLZ。对于前两组，同时进行动脉瘤腔内隔绝术和去分支术，而对于接受初始象鼻手术的组，手术分期。患者平均年龄为64 ± 13岁。一次技术成功率100%。30天/住院期间死亡、卒中和永久性截瘫/轻瘫的发生率分别为0%、0%和3.6%（n = 1）。在平均随访14 +/- 11个月时，未发生晚期血栓相关事件。2例患者（7%）因1型血管内泄漏需要二次血管内再介入。在最近的随访中，没有患者发生1型或3型血管内泄漏。在中期随访时，横主动脉弓动脉瘤的混合修复似乎是安全有效的，可能代表了这种病理治疗的技术进步。
Background. Aneurysms of the transverse aortic arch, especially those involving the mid to distal arch, are technically challenging to repair with conventional open techniques. We present our results with a combined open/endovascular approach ("hybrid repair") in such patients.Methods. From August 11, 2005, to September 18, 2008, 28 patients underwent hybrid arch repair. For patients (n = 9) with distal arch aneurysms but 2 cm or more of proximal landing zone (PLZ) distal to the innominate artery, right to left carotid-carotid bypass was performed to create a PLZ by covering the left carotid origin. For patients (n = 12) with mid arch aneurysms but 2 cm or more of PLZ in the ascending aorta, proximal ascending aorta-based arch debranching was performed. For patients (n = 7) with arch aneurysms with no adequate PLZ ("mega aorta") but adequate distal landing zone, a stage 1 elephant trunk procedure was performed to create a PLZ. For the first two groups, endovascular aneurysm exclusion and debranching were performed concomitantly, whereas the procedures were staged for the group undergoing an initial elephant trunk procedure.Results. Mean patient age was 64 +/- 13 years. Primary technical success rate was 100%. Thirty-day/in-hospital rates of death, stroke, and permanent paraplegia/paresis were 0%, 0%, and 3.6% (n = 1), respectively. At a mean follow-up of 14 +/- 11 months, there have been no late aortic-related events. Two patients (7%) required secondary endovascular reintervention for a type 1 endovascular leak. No patient has a type 1 or 3 endovascular leak at latest follow-up.Conclusions. Hybrid repair of transverse aortic arch aneurysms appears safe and effective at midterm follow-up and may represent a technical advance in the treatment of this pathology.