累及主动脉弓部病变的完全腔内治疗:95例中长期随访结果

目的探讨完全腔内技术治疗累及主动脉弓部病变的中长期随访结果。方法回顾性分析2010年1月~2017年12月95例应用完全腔内技术处理累及主动脉弓部病变的临床资料,其中烟囱支架技术81例,“开窗”技术8例(原位4例,体外4例),分支支架技术6例。结果共植入胸主动脉覆膜支架主体95枚,重建主动脉弓部分支动脉124支,其中无名动脉7支,左颈总动脉36支,左锁骨下动脉81支。2例原位开窗失败中转烟囱技术重建分支。术中Ⅰ型内漏11例(11.6%),其中5例弹簧圈栓塞后消失,6例轻微内漏随访观察。技术成功率91.6%(87/95)。围术期死亡3例(3.2%),一过性截瘫1例(1.1%),脑梗死2例(2.1%),急性心肌梗死2例(2.1%),急性肺损伤1例(1.1%)。存活92例中随访83例,随访率90.2%。1例术后4个月死于脑梗死,1例术后6个月因多器官功能衰竭死亡,其余81例随访时间28~106(58.9±17.9)月,其中73例>36个月。8例因Ⅰ型内漏行二次手术栓塞,未见支架移位、狭窄、闭塞等并发症。结论通过多种完全腔内技术重建各主动脉弓部的分支血管,为累及主动脉弓部病变提供微创治疗机会,中长期随访结果满意。

Total Thoracic Endovascular Aortic Repair for Lesions Involving Aortic Arch: Mid-to Long-term Results of 95 Cases

Objective To explore the mid-to long-term outcomes of total thoracic endovascular aortic repair(TEVAR)of lesions involving the aortic arch.Methods Data of 95 patient receiving TEVAR with supra-arch branch endovascular reconstruction from January 2010 to December 2017 were retrospectively collected and analyzed.Peri-operative complications and follow-up outcomes were recorded and analyzed.Methods of branch reconstruction were chimney technique in 81 cases,fenestration in 8 cases(4 in situ and 4 in vitro),and single branched graft in 6 cases.Results A total of 95 main stent grafts were implanted,and 124 supra-arch branches were reconstructed including 7 innominate artery(IA),36 left common carotid artery(LCCA),and 81 left subclavian artery(LSA).Two cases were converted to chimney grafts because of in-situ fenestration failure.TypeⅠendoleak occurred in 11 patients(11.6%),5 of which were cured after coil embolization and 6 of which had minimal endoleak left for follow-up observation.The technical success rate was 91.6%(87/95).Post-operative events included 3 deaths(3.2%),1 transient paraplegia(1.1%),2 cerebral infarctions(2.1%),2 acute cardiac infarctions(2.1%),and 1 pulmonary injury(1.1%).Among the 92 survived patients,83 were followed up,with a follow-up rate of 90.2%.One patient died of cerebral infarction at 4 months.One patient died of multi-organ function failure at 6 months.The other 81 patients were followed up for 28-106 months with an average period of(58.9±17.9)months,including 73 patients for more than 36 months.No rupture or aortic related death was determined.Eight patients received reintervention for typeⅠendoleak.Based on the follow-up data analysis,no adverse events were reported,including graft migration,branch stenosis or occlusion.Conclusion TEVAR with total endovascular supra-arch branch reconstruction may be a safe and durable strategy for lesions involving the aortic arch in selected patients.