Multicenter Analysis of Endovascular Aortic Arch In Situ Stent-Graft Fenestrations for Aortic Arch Pathologies
Multicenter Analysis of Endovascular Aortic Arch In Situ Stent-Graft Fenestrations for Aortic Arch Pathologies
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DOI：
10.1016/j.avsg.2019.02.005
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发表时间：
2019-08-01
影响因子：
1.5
通讯作者：
Miller, D. F.
中科院分区：
文献类型：
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作者：
Kopp, Reinhard;Katada, Yoshiaki;Miller, D. F.
背景：原位开窗主动脉覆膜支架治疗主动脉弓动脉瘤是主动脉弓腔内修复术的一种新选择。到目前为止，只有少数报告显示了主动脉弓疾病原位开窗术的围手术期和短期结果。我们提出了多中心的经验，主动脉弓原位开窗技术记录在AARCHIF注册表治疗主动脉弓动脉瘤或局部A型主动脉夹层，并分析围手术期的结果和中期follow-up.Methods：患者主动脉弓病变治疗主动脉弓原位开窗与近端覆膜支架降落在主动脉弓Ishimura区0和1被列入注册表。使用针或射频或激光导管创建覆膜支架原位开窗，并通过植入覆膜连接覆膜支架完成。结果：2009年6月至2017年3月，7个不同国家的9家机构对25例患者进行了主动脉弓病变的原位覆膜支架开窗术治疗，其中3例为覆膜支架错位的紧急手术。对头臂干（n = 20）、左颈总动脉（n = 21）和LSA（n = 9）进行原位开窗术。预期原位开窗术的技术成功率为94.0%（47/50），在14例患者中进行了额外的主动脉上旁路手术。1例（4.0%）患者发生围手术期死亡，作为补救手术治疗，观察到3例（12.0%）围手术期卒中。1例近端主动脉覆膜支架对线不良和4例III型内漏（2例早期和2例晚期）需要再次介入治疗。在随访期间（1-118个月），主动脉弓动脉瘤的直径从61.5 +/- 4.1 mm降至48.4 +/- 3.2 mm（P = 0.02），到目前为止，6例患者死于与其主动脉弓病理无关的疾病，平均生存时间为79.5个月，并进行了3次血管内再介入远端主动脉扩张。脑血管事件（n = 4）是中期随访期间死亡率最相关的预后因素（P = 0.003）。结论：主动脉弓原位开窗技术进行腔内主动脉弓修复术似乎是有价值的治疗选择，为选定的患者，虽然最初考虑其他治疗方案是强制性的。需要长期耐久性数据。
Background: In situ fenestration of aortic stent grafts for treatment of aortic arch aneurysms is a new option for endovascular aortic arch repair. So far, only few reports have shown perioperative and short-term results of in situ fenestrations for aortic arch diseases. We present the multicenter experience with the aortic arch in situ fenestration technique documented in the AARCHIF registry for treatment of aortic arch aneurysms or localized type A aortic dissections and analyzed perioperative outcome and midterm follow-up.Methods: Patients with aortic arch pathologies treated by aortic arch in situ fenestration with proximal stent graft landing in aortic arch Ishimura zones 0 and 1 were included in the registry. Stent-graft in situ fenestrations were created using needles or radiofrequency or laser catheters and completed by implantation of covered connecting stent grafts. Single in situ fenestrations for the left subclavian artery (LSA) were excluded.Results: Between 06/2009 and 03/2017, twenty-five patients were treated by in situ stent-graft fenestrations for aortic arch pathologies at 9 institutions in 7 different countries, 3 of them as bailout procedures for stent-graft malplacement. In situ fenestrations were performed for the bra-chiocephalic trunk (n = 20), the left common carotid artery (n = 21) and the LSA (n = 9). Technical success for intended in situ fenestrations was 94.0% (47/50), with additional supraaortic bypass procedures performed in 14 patients. Perioperative mortality occurred in 1 (4.0%) patient, treated as a bailout procedure and 3 (12.0%) perioperative strokes were observed. One proximal aortic stent-graft nonalignment and 4 type III endoleaks, 2 early and 2 late, required reeintervention. During follow-up (1-118 months), the diameter of aortic arch aneurysms decreased from 61.5 +/- 4.1 mm to 48.4 +/- 3.2 mm (P = 0.02) and, so far, 6 patients died from diseases unrelated to their aortic arch pathologies with a mean survival time of 79.5 months and 3 endovascular reinterventions for distal aortic expansion were performed. Cerebrovascular event (n = 4) was the most relevant prognostic factor for mortality during midterm follow-up (P = 0.003).Conclusions: The aortic arch in situ fenestration technique for endovascular aortic arch repair seems to be valuable treatment option for selected patients, although initial consideration of other treatment options is mandatory. Data about long-term durability are required.