Best surgical option for arch extension of type B dissection: the endovascular approach
Best surgical option for arch extension of type B dissection: the endovascular approach
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DOI：
10.3978/j.issn.2225-319x.2014.04.04
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发表时间：
2014-05-01
影响因子：
3.1
通讯作者：
Kuratani, Toru
中科院分区：
文献类型：
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作者：
Kuratani, Toru
尽管手术技术和术后管理取得了进步，但接受传统开放手术修复B型夹层的患者的院内死亡率仍然很高。鉴于此，开发了急性B型主动脉夹层的微创外科手术，定义为胸主动脉腔内修复术（TEVAR）。尽管存在一些争议，但使用TEVAR治疗B型主动脉夹层已变得司空见惯。通常，B型主动脉夹层的主要入口撕裂位于左锁骨下动脉（LSA）的开口附近。只要TEVAR治疗B型夹层的目的是一期入口闭合，就必须固定主动脉弓中的近端锚定区。这就需要混合手术，包括开放性手术的使用，如颈支血管重建的去分支。尽管主动脉弓存在具有挑战性的解剖条件，但混合修复已发展成为一种日益可行的替代方案，并已报告了有希望的早期和长期结果。作为下一步，开窗和分支TEVAR技术最近已报告了令人满意的早期结果。在未来几年，将有激烈的竞争，以开发设备本身，改善输送系统，并补充设备的辅助功能。因此，对下一代以及它们将如何改进和推进用于B型主动脉夹层的TEVAR治疗方法有很高的期望。
Despite advances in surgical techniques and postoperative management, the in-hospital mortality rate for patients undergoing conventional open surgical repair for type B dissections is still significant. In light of this, the less invasive surgical procedure for acute type B aortic dissections, defined as thoracic endovascular aortic repair (TEVAR), was developed. Despite some controversy, the use of TEVAR for the management of type B aortic dissections has become commonplace. Generally, the main entry tear in type B aortic dissection is located in the vicinity of the orifice of the left subclavian artery (LSA). The proximal landing zone in the aortic arch must be secured as long as the aim of TEVAR for type B dissection is primary entry closure. This requires hybrid surgery that includes the use of open surgical procedures, such as debranching for revascularization of cervical branches. Despite the presence of challenging anatomic conditions in the aortic arch, hybrid repair has evolved as an increasingly viable alternative, and promising early and long-term results have been reported. As the next step, fenestrated and branched TEVAR techniques have recently been reported with satisfactory early results. In the coming years, there will be intense competition to develop the devices themselves, improve delivery systems, and supplement devices with auxiliary functions. Thus there is high expectations for the next generation and how they will improve and advance treatment methods of TEVAR for type B aortic dissections.