预开窗与原位开窗技术在胸主动脉腔内修复术中的联合应用

Combination of physician modified stent-graft fenestration and in-situ needle fenestration during thoracic endovascular aortic repair

目的:探讨胸主动脉腔内修复手术中近端锚定区位于Z0或Z1区时采用预开窗联合针刺原位开窗重建弓上动脉的效果。方法:回顾性分析2017年11月至2019年12月18例锚定区位于Z0或Z1区并采用预开窗联合针刺原位开窗重建患者的临床资料。结果:16例采用预开窗保留左颈动脉,2例采用预开窗保留无名动脉和左颈动脉,18例均采用原位开窗重建左锁骨下动脉。本组分支动脉保留成功率100%(38/38)。即时Ⅰ、Ⅱ、Ⅲ、Ⅳ型内漏各为0、4、1、4例。中位随访时间12个月,1例术后12个月因脑出血死亡,1例Ⅲ型内漏患者术后6个月行开胸主动脉弓替换术,无其他不良事件。结论:锚定区位于Z0或Z1区的胸主动脉腔内修复手术中,预开窗联合原位开窗的复合术式近期随访结果满意。两种技术的熟练掌握和病例的严格选择是减少并发症的关键。

Objective To evaluate the safety and feasibility of the in-situ needle fenestration combined with the in vitro physician modified fenestration technique to reconstruct supra-aortic branches during thoracic endovascular aortic repair(TEVAR)for aortic arch lesions requiring landing at Z0 and Z1.Methods From Nov 2017 to Dec 2019,eighteen patients who underwent both the in-situ needle fenestration and the in vitro physician modified fenestration techniques to extend the proximal landing zone to Z0 and Z1 during TEVAR were included in our study.Results Sixteen patients underwent in vitro physician modified fenestration,two patients underwent in vitro physician modified fenestration to reconstruct both the left common carotid artery and the innominate artery.All eighteen patients received in-situ needle fenestration to preserve the left subclavian artery.Supra aortic branches were preserved in all patients(38/38,100%).There was no TypeⅠendoleak.TypeⅡendoleak was found in four paitnets(4/18).TypeⅢendoleak occurred in one patient(1/18).TypeⅣendoleak in four patients(4/18).TypeⅢendoleak needed open aortic arch repair 6 months later.The median follow-up time was 12 months.One(1/18)died in 12 months and the other patients were doing well.Conclusions The joint application of the in-situ needle fenestration and the in vitro physician modified fenestration to reconstruct supra-aortic branches during TEVAR for aortic arch pathologies requiring landing at Z0 and Z1 was satisfactory.