体外预开窗技术腔内治疗胸腹主动脉疾病:单中心回顾性研究

Endovascular aortic repair with surgeon-modified fenestrated stent-graft for thoracoabdominal pathologies:A single-center retrospective report

目的评估应用体外预开窗技术腔内治疗复杂胸腹主动脉疾病的安全性和可行性。方法回顾性分析2020年1月至2022年3月海军军医大学附属长海医院开展体外预开窗技术腔内治疗的22例胸腹主动脉疾病患者临床资料,其中Stanford B型主动脉夹层9例,主动脉瘤6例,腔内隔绝术后内漏4例,假性动脉瘤2例,主动脉局限性夹层合并主动脉瘤1例。结果手术成功率为100%,共重建87支内脏分支动脉,其中采用三开窗5例,四开窗17例。2例患者在围术期死亡,其中心源性猝死1例,再干预后多脏器功能衰竭1例。患者术后随访6~30个月,平均(17.0±7.6)个月,4例患者在随访期间死亡,3例患者接受再干预,包括Ⅰb型内漏1例,Ⅱ型内漏1例,非风湿性心脏瓣膜病1例。结论体外预开窗技术腔内治疗复杂胸腹主动脉扩张性疾病的短中期效果满意,安全可行。

Objective To evaluate the safety and feasibility of endovascular aortic repair with surgeon-modified fenestrated stent-graft for thoracoabdominal pathologies.Methods The clinical data of 22 patients with thoracoabdominal pathologies who underwent endovascular aortic repair with surgeon-modified fenestrated stent-grafts for in Changhai Hospital affiliated to Naval Medical University between January 2020 and March 2022 were retrospectively analyzed.There were 9 cases of Stanford type B aortic dissection,6 cases of aortic aneurysm,4 cases of endoleak after previous endovascular repair,2 cases of pseudoaneurysm and 1 case of aortic aneurysm with confined aortic dissection.Results Technical success rate was 100%.87 visceral arteries were revascularized successfully.Triple fenestrations were applied in 5 cases,and quadruple fenestrations were applied in 17 cases.There were two deaths in the perioperative period,including one case of cardiac arrest and one case of multiorgan failure after reintervention.Patients were followed-up for 6-30 months,with the mean time of 17.0±7.6 months.During the follow-up,there were four deaths and three reinterventions,including one case of type Ib endoleak,one case of typeⅡendoleak and one case of non-rheumatic valvular heart disease.Conclusion The safety and feasibility of endovascular aortic repair with surgeon-modified fenestrated stent-graft for thoracoabdominal pathologies are satisfactory.