腔内治疗主动脉弓部病变的单中心疗效分析

Efficacy analysis of endovascular treatment of aortic arch lesion from a single center

目的探讨使用全腔内方式治疗累及弓上动脉分支的主动脉弓部病变的治疗效果。方法回顾性分析2010年1月至2021年8月中山大学附属第一医院血管外科接受弓上分支重建的127例主动脉弓病变患者的临床资料。其中B型夹层43例,弓部穿透性溃疡25例,弓部动脉瘤25例,弓部慢性夹层动脉瘤9例,逆撕A型夹层9例,弓部假性动脉瘤2例及弓部壁间血肿2例。收集患者伴随疾病、手术数据等资料,通过术后随访,了解患者术后生存状态、并发症发生及二次干预等情况,应用Kaplan-Meier法计算累积生存率、内漏发生率及二次干预率。结果本组患者手术时间(165.7±89.5)min,技术成功率100%。术中植入胸主动脉覆膜支架127枚,涉及147条弓上分支动脉重建。术后内漏23例。术后ICU监护43例,围术期并发症发生19例,死亡及二次干预均为5例。术后住院时间(8.9±6.7)d。109例获得随访,中位随访时间30(11,53)个月,随访期全因死亡17例。Kaplan-Meier生存曲线显示术后1、3、5及10年累积生存率分别为(94.9±2.2)%、(87.2±4.2)%、(68.5±7.1)%和(61.7±9.1)%,1年和10年内漏发生率分别为(14.6±3.6)%和(33.9±15.1)%,1年和10年累积二次干预率分别为(2.1±1.5)%和(21.7±17.6)%。烟囱、开窗及分支支架重建左锁骨下动脉,36个月内漏发生率分别为(22.0±7.4)%、(8.3±8.0)%及(4.2±4.1)%。结论腔内治疗主动脉弓部病变安全有效,围术期及远期疗效均较满意。

Objective To evaluate clinical effect of total endovascular treatment for aortic arch diseases involving supra-aortic branches.Methods Clinical data of 127 patients with aortic arch disease who underwent reconstruction of supra-aortic branches in Department of Vascular Surgery,the First Affiliated Hospital of SYSU from January 2010 to August 2021 were retrospectively analyzed.Diseases included Stanford type B aortic dissection(n=43),penetrating ulcers(n=25),arch aneurysm(n=25),chronic dissecting aneurysms(n=9),retrograde Stanford type A aortic dissection(n=9),pseudoaneurysm(n=2),and intermural hematoma(n=2).Data of concomitant disease and surgery of patients were collected.Survival situation,complications,and re-intervention of patients were known through follow-up after surgery.Cumulative survival rate,endoleak rate,and re-intervention rate were calculated using the Kaplan-Meier method.Results Operation time was(165.7±89.5)min and technical success rate was 100%.A total of 127 thoracic aorta covered stent grafts were implanted,while 147 supra-aortic branches were reconstructed during operation.Endoleak occurred in 23 patients,ICU monitoring was performed in 43 cases after the surgery.Perioperative complications were observed in 19 patients,death and re-intervention both occurred in 5 cases.Postoperative hospital stay was(8.9±6.7)days.A total of 109 patients were followed up and the median follow-up time was 30 months.All-death mortality occurred in 17 patients during follow-up period.Kaplan-Meier survial curve showed the overall cumulative survival rate of 1-,3-,5-and 10-year were(94.9±2.2)%,(87.2±4.2)%,(68.5±7.1)%and(61.7±9.1)%,respectively.1-,10-year endoleak rate and cumulative re-intervention rate were(14.6±3.6)%,(33.9±15.1)%and(2.1±1.5)%,(21.7±17.6)%,respectively.Compared with chimney stent,fenestration and branched stent-grafts have a lower incidence of long-term endoleak.Conclusion Endovascular treatment of aortic arch diseases is safe and effective,its perioperative and long-term efficacy is satisfactory.