In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair.
In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair.
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原位激光开窗术是胸主动脉腔内修复术中主动脉弓血运重建的一种可行方法
DOI：
10.1161/jaha.116.004542
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发表时间：
2017-04-21
影响因子：
5.4
通讯作者：
Lu X
中科院分区：
文献类型：
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作者：
Qin J;Zhao Z;Wang R;Ye K;Li W;Liu X;Liu G;Cui C;Shi H;Peng Z;Yuan F;Yang X;Lu M;Huang X;Jiang M;Wang X;Yin M;Lu X
研究背景胸主动脉腔内修复术中主动脉主要分支的重建因其复杂的解剖结构和变异性而复杂，原位激光开窗术在主动脉分支血管重建中显示出巨大的潜力。本研究旨在评价胸主动脉腔内修复术中主动脉弓三个分支的原位激光开窗术的可行性、有效性和安全性。方法和结果在临床应用前，通过810 nm激光系统离体对聚四氟乙烯和涤纶覆膜支架进行开窗，该系统不会损坏覆膜支架的裸金属部分，并在保持覆膜支架完整性的同时创建干净的开窗。在体内，6只麻醉的雌性猪在该手术后存活，包括主动脉弓中的覆膜支架植入、激光开窗术以及通过无名动脉和左颈动脉的导管植入。在动物实验的基础上，对24例（年龄33-86岁）胸主动脉病变患者（夹层A型4例，B型7例，动脉瘤2例，附壁血栓7例）进行了胸主动脉腔内修复术中的原位激光开窗术。2例（8.3%）患者行3个主动脉分支开窗术。6例（25%）患者的左颈动脉和左锁骨下动脉均开孔。16例（66.7%）仅行左锁骨下动脉开窗术。其中1例因III型主动脉弓无名动脉急性离断而放弃开窗术，平均手术时间为137±15分钟。技术成功率为95.8%（n=23）。这次手术后没有发生与开窗相关的并发症或神经系统疾病。在平均术后10个月随访期间（范围：2-17个月），1例患者死于重度肺炎，所有左锁骨下动脉和颈动脉支架均通畅，计算机断层扫描血管造影图像显示无开窗相关内漏。结论原位激光开窗术是胸主动脉腔内修复术中重建主动脉弓的一种可行、有效、快速、可重复、安全的方法，可实现3支血管的重建。但是，应延长随访期，以评价该技术的稳健性。
Background Reconstruction of the aortic major branches during thoracic endovascular aortic repair is complicated because of the complex anatomic configuration and variation of the aortic arch. In situ laser fenestration has shown great potential for the revascularization of aortic branches. This study aims to evaluate the feasibility, effectiveness, and safety of in situ laser fenestration on the three branches of the aortic arch during thoracic endovascular aortic repair. Methods and Results Before clinical application, the polytetrafluoroethylene and Dacron grafts were fenestrated by an 810‐nm laser system ex vivo, which did not damage the bare metal portion of the endografts and created a clean fenestration while maintaining the integrity of the endografts. In vivo, 6 anesthetized female swine survived after this operation, including stent‐graft implantation in the aortic arches, laser fenestration, and conduit implantation through the innominate arteries and the left carotid arteries. Based on the animal experiments, in situ laser fenestration during thoracic endovascular aortic repair was successively performed on 24 patients (aged 33–86 years) with aortic artery diseases (dissection type A: n=4, type B: n=7, aneurysm: n=2, mural thrombus: n=7). Fenestration of 3 aortic branches was performed in 2 (8.3%) patients. Both the left carotid artery and the left subclavian artery were fenestrated in 6 (25%) patients. Only left subclavian artery fenestration surgery was done in 16 (66.7%) patients. Among these patients, 1 fenestration was abandoned secondary to an acute takeoff of the innominate artery in a type III aortic arch. The average operative time was 137±15 minutes. The technical success rate was 95.8% (n=23). No fenestration‐related complications or neurological morbidity occurred after this operation. During a mean postoperative 10‐month follow‐up (range: 2–17 months), 1 patient died of severe pneumonia, and all the left subclavian artery and carotid artery stents were patent with no fenestration‐related endoleaks upon computed tomography angiography images. Conclusions In situ laser fenestration is a feasible, effective, rapid, repeatable, and safe option for the reconstruction of aortic arch during thoracic endovascular aortic repair, which might be available to revascularize the 3 branches. However, follow‐up periods should be extended to evaluate the robustness of this technique.