Thoracic endovascular aortic repair for degenerative distal arch aneurysm can be used as a standard procedure in high-risk patients
Thoracic endovascular aortic repair for degenerative distal arch aneurysm can be used as a standard procedure in high-risk patients
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DOI：
10.1093/ejcts/ezw020
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发表时间：
2016-08-01
影响因子：
3.4
通讯作者：
Sawa, Yoshiki
中科院分区：
文献类型：
--
作者：
Shijo, Takayuki;Kuratani, Toru;Sawa, Yoshiki
近年来，用于治疗主动脉弓病变的主动脉瓣上改道和胸主动脉腔内修复术(TEVAR)已成为高危患者的一种侵入性较小的选择。这项研究旨在评估我们预防中风和改善主动脉瓣上重建术和TEVAR后远期预后的策略。从2008年7月到2015年7月，我们使用自制的支架移植物进行了280例弓部病变的TEVAR。这项研究回顾了101例行主动脉上改道和TEVAR治疗退行性远端弓部动脉瘤的患者(80名男性，平均年龄73.1岁，1区/2区=48/53)。自2011年以来，我们常规应用脑保护方法，在TEVAR前阻断左颈总动脉(LCA)和左锁骨下动脉(LSA)的自然前向血流，阻断LSA，阻断LSA，平均手术时间178±65min。卒中死亡率和30天死亡率分别为3%和1%。在引入脑保护措施之前，卒中的围术期危险因素为动脉粥样硬化A级/千分之III(P=0.035)。近端着陆区(P=0.58)和LSA牺牲(P=1.00)不是卒中的危险因素。使用脑保护方法后无卒中发生(保护前：6%，保护后：0%)。就晚期结果而言，1年和4年的大动脉相关死亡率分别为97%和95%。术后1年和4年的无主动脉事件发生率分别为91%和86%。在随访期间，没有发生Ia型内漏，观察到一例A型夹层。我们的主动脉上重建术和TEVAR策略显示出令人满意的早期和晚期结果。围术期卒中的主要危险因素是动脉粥样硬化，在TEVAR手术前阻断来自LCA和LSA的天然前向血流有助于预防卒中。
In recent years, supra-aortic rerouting and thoracic endovascular aortic repair (TEVAR) for treating aortic arch pathology have emerged as a less invasive option for high-risk patients. This study aimed to assess our strategy for preventing stroke and improving late outcomes after supra-aortic rerouting and TEVAR.Between July 2008 and July 2015, we performed 280 cases of TEVAR for arch pathologies, using manufactured stent grafts. This study reviewed 101 patients who underwent supra-aortic rerouting and TEVAR for degenerative distal arch aneurysms (80 men, mean age 73.1 years, Zone 1/Zone 2 = 48/53). Since 2011, we have routinely used the brain protection method, which comprises blocking native forward flow from the left common carotid artery (LCA) and left subclavian artery (LSA) for zone 1 cases and the LSA for zone 2 cases before TEVAR.The mean operation time was 178 +/- 65 min. The stroke and 30-day death rates were 3 and 1%, respectively. Before the brain protection method was introduced, the perioperative risk factor for stroke was atheroma Grade a parts per thousand yenIII (P = 0.035). Proximal landing zone (P = 0.58) and LSA sacrifice (P = 1.00) were not risk factors for stroke. No strokes occurred after using the brain protection method (before protection: 6% and after protection: 0%). Regarding late results, the rate of freedom from aorta-related death at 1 and 4 years was 97 and 95%, respectively. The rate of freedom from aortic events at 1 and 4 years was 91 and 86%, respectively. During follow-up, no type Ia endoleak developed and one type A dissection was observed.Our strategy for supra-aortic rerouting and TEVAR showed satisfactory early and late results. The chief risk factor for perioperative stroke was atheroma, and blocking native forward flow from the LCA and the LSA prior to the TEVAR procedure helped prevent stroke.