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首页> 外文期刊>Journal of endovascular therapy: an official journal of the International Society of Endovascular Specialists >Homemade Fenestrated Stent-Grafts for Complete Endovascular Repair of Aortic Arch Dissections
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Homemade Fenestrated Stent-Grafts for Complete Endovascular Repair of Aortic Arch Dissections

机译：自制的飞齿支架移植物，用于主动脉弓解剖的完全血管内修复

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摘要

Purpose: To evaluate outcomes of homemade fenestrated stent-grafts for complete endovascular aortic repair of aortic arch dissections. Materials and Methods: From July 2014 through September 2018, 35 patients (mean age 66 +/- 11 years; 25 men) underwent homemade fenestrated stent-graft repair of acute (n=16) or chronic (n=10) complicated type B aortic dissections (n=16) and dissecting aortic arch aneurysms subsequent to surgical treatment of acute type A dissections (n=9). Nineteen (54%) procedures were emergent. Results: Zone 2 single-fenestrated stent-grafts were used in 25 cases; the remaining 10 were double-fenestrated stent-grafts deployed in zone 0. Median time for stent-graft modification was 18 minutes (range 16-20). Technical success was achieved in all cases. An immediate distal type I endoleak was treated intraoperatively. Among the double-fenestrated stent-graft cases, the left subclavian artery fenestration could not be cannulated in 2 patients and revascularization was required. Partial coverage of the left common carotid artery necessitated placement of a covered stent in 3 cases. One (3%) patient had a stroke without permanent sequelae. Two type II endoleaks required additional covered stent placement at 5 and 7 days postoperatively, respectively. The 30-day mortality was 6% (2 patients with ruptured aortic arch aneurysm). During a mean follow-up of 17.6 +/- 13 months, there was no aortic rupture or retrograde dissection. One late type I endoleak was treated with additional proximal fenestrated stent-graft placement. One type II endoleak is currently under observation. One additional patient died (unrelated to the aorta); overall mortality was 9%. All supra-aortic trunks were patent. Conclusion: The use of homemade fenestrated stent-grafts for endovascular repair of aortic arch dissections is feasible and effective for total endovascular aortic arch repair. Durability concerns will need to be assessed in additional studies with long-term follow-up.
机译：目的：评估自制近期支架移植物的成果，以实现主动脉弓解剖的完全血管内主动脉修复。材料和方法：2014年7月至2018年9月，35名患者（平均年龄为66 +/- 11岁; 25名男性）经过自制的释放支架修复急性（n = 16）或慢性（n = 10）复杂的b主动脉夹层（n = 16），并在急性型侵略治疗后剖析主动脉弓动脉瘤（n = 9）。 19（54％）的程序是紧急的。结果：25例中使用4区2型单烯烃支架移植物;其余10位是在区域中部署的双重前支架移植物。支架移植改性的中值时间为18分钟（范围为16-20）。在所有情况下都取得了技术成功。直接远端型InatoReak被术中处理。在双封成的支架移植案件中，左亚克拉夫动脉衰生不能在2名患者中插管，并且需要血运重建。左侧常见的颈动脉部分覆盖需要在3例中覆盖支架的放置。一（3％）患者在没有永久性后遗症的情况下卒中。两种类型的II型螺旋凸术术后需要额外的覆盖支架放置在术后5和7天。 30天的死亡率为6％（2例主动脉弓动脉瘤患者）。在17.6 +/- 13个月的平均随访期间，没有主动脉破裂或逆行解剖。一件末期的I exoleak是用额外的近端的近端的支架置置进行处理。目前正在观察中的II型IndoReak。一个额外的患者死亡（与主动脉无关）;总体死亡率为9％。所有Supra-主动脉中继都是专利。结论：采用自制的近期支架移植物用于主动脉弓解剖的血管内修复是对总血管内主动脉弓修复的可行和有效。耐用性担忧需要在额外的研究中进行评估，并进行长期随访。

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