In situ needle fenestration thoracic endovascular aortic repair for treating aortic dissection involving aortic arch
10.13929/j.issn.1672-8475.2024.09.002
- VernacularTitle:针刺原位开窗胸主动脉腔内修复术治疗主动脉夹层累及主动脉弓
- Author:
Junlong ZHU
1
,
2
;
Tongjie XU
;
Peng LI
;
Jianghong DAI
;
Hao CHEN
;
Wei DOU
;
Yong LIU
;
Huqiang HE
Author Information
1. 西南医科大学附属医院血管外科,四川 泸州 646000
2. 西南医科大学心血管医学研究所,医学电生理学教育部重点实验室,四川心血管病防治协同创新中心,四川 泸州 646000
- Keywords:
aortic dissection;
thoracic endovascular aortic repair;
in situ fenestration;
therapeutic effect
- From:
Chinese Journal of Interventional Imaging and Therapy
2024;21(9):517-521
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the effect of in situ needle fenestration thoracic endovascular aortic repair(TEVAR)for treating aortic dissection(AD)involving aortic arch.Methods Data of 16 patients with AD involving aortic arch who underwent in situ needle fenestration TEVAR for reconstruction of aortic arch branches were retrospectively analyzed,and the number of fenestration,technical success rate and TEVAR related complications were recorded.Regular follow-up was conducted after TEVAR,the repair of dissection and the patency of fenestrated branch blood vessels were evaluated,the endoleak was assessed,and the survival of patients were recorded.Results The main aortic stent was successfully implanted in all 16 cases.Among them,4 received triple fenestration stent implantation in zones Z0,Z1 and Z2,6 received double fenestration stent implantation in zones Z1 and Z2,2 received double fenestration stent implantation in zones Z0 and Z1 and 4 received single fenestration stent implantation in zone Z2.The success rate of brachiocephalic trunk(BCT)fenestration was 83.33%(5/6).Left common carotid artery(LCCA)-right common carotid artery bypass was performed in 1 case without successful fenestration.The success rate of LCCA fenestration was 100%(12/12).The success rate of left subclavian artery(LSA)fenestration was 87.50%(14/16),2 cases with not successful fenestration were treated with axillar-axillary artery artificial vascular bypass.The technical success rate of intervention was 100%(16/16).Type Ⅰa endoleak occurred in 1 case during TEVAR process and improved after embolization with spring coil.One patient died of pericardial tamponade at the end of TEVAR.Fifteen patients were followed up for a median follow-up time of 20 months.During this period,transient ischemic attack and local small dissection at the proximal beginning of the main stent occurred each in 1 case,which improved after no special treatment.Type Ⅰ endoleak occurred in 1 case,type Ⅲ endoleak occurred in 2 cases,all improved after proximal fenestrated membrane stent implantation or spring coil embolization treatment.One case died of coronary heart disease.Conclusion In situ needle fenestration TEVAR was effective and safe for treating AD involving aortic arch.
