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Endovascular Treatment of Aortic Arch Lesions Using Scalloped Endografts

机译：使用扇形内血血移植物的主动脉弓病变的血管内治疗

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Objective: To present our early and midterm results using thoracic endovascular aortic repair (TEVAR) with a custom-made proximal scalloped stent graft to accommodate left common carotid artery (LCCA) and innominate artery (IA) in treating aortic lesions involving the arch. Materials and Methods: Between February 2014 and April 2017, select patients presenting with aortic arch lesions and short proximal landing zone were treated by proximal scalloped Relay Plus stent grafts. Patient demographics, operative details, clinical outcomes, and complications were analyzed. Results: Six patients (50% male) with a median age of 71 years (range, 60-82) underwent scalloped TEVAR using thoracic custom-made Relay Plus stent graft to preserve flow in the proximal supra-aortic trunks. Target vessels for the scallop were LCCA in 5 cases and IA in 1 case. The technical success rate was 100%, and proximal seal was achieved in all cases with no type I endoleaks on completion angiography. The median follow-up period was 20 (7-32) months. No conversion to open surgical repair and no aortic rupture occurred. One patient had a distal type I endoleak on the 6-month computed tomography (CT) scan, and 1 patient had a proximal type I endoleak on the 12-month CT scan. There was no stroke, paraplegia, retrograde type A dissection, or other aortic-related complication. We routinely used temporary rapid right ventricular pacing to obtain a near-zero blood pressure level during the graft deployment. No complications were observed related to the use of rapid pacing. Conclusion: When anatomy allows, proximal scalloped stent graft to accommodate LCCA and IA is a viable therapeutic option in treating aortic lesions involving the arch with short proximal landing zones. In addition, these findings represent a strong argument for the use of temporary rapid pacing during graft deployment.
机译：目的：介绍我们的早期和中期结果，使用胸内血管主动脉修复（TEVAR）与定制的近端扇形支架移植物，以适应左常见的颈动脉（LCCA）和无名的动脉（IA）治疗涉及拱的主动脉病变。材料和方法：2014年2月至2017年4月，选择患有主动脉弓病变和短近侧着陆区的患者进行近端扇形继电器加上支架移植物。分析了患者人口统计学，手术细节，临床结果和并发症。结果：6名患者（50％雄性），中位数为71岁（范围，60-82），使用胸部定制继电器加上支架移植物，以保护近端上颌 - 主动脉中继线的扇形Tevar。扇贝的目标船只在5例和IA中为1例。技术成功率为100％，并且在完成血管造影上没有I型Inteo odeaks的所有情况下实现了近端密封。中位随访期为20（7-32）个月。没有转化为开放手术修复，并且没有发生主动脉破裂。一名患者在6个月的计算机断层扫描（CT）扫描上有一个远端I EndoReak，1名患者在12个月CT扫描上有一个近端I型EndoLeak。没有中风，截瘫，逆行型分析，或其他相关的并发症。我们经常使用临时快速右心室起搏，在移植部署期间获得近零的血压水平。没有观察到与快速起搏有关的并发症。结论：当解剖允许，近端扇形支架移植物容纳LCCA和IA是一种可行的治疗方法，治疗涉及短近侧着陆区的拱形的主动脉病变。此外，这些调查结果代表了在移植部署期间使用临时快速起搏的强大论据。

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