Mid-term Comparison of One-Piece Branched Stent-Graft and Chimney Technique Treating Aortic Arch Pathologies

被引:7
|
作者
Wu, Mingwei [2 ]
Zhao, Yuxi [2 ]
Zeng, Zhaoxiang [2 ]
Bao, Xianhao [2 ]
Li, Tao [2 ]
Feng, Rui [1 ]
Feng, Jiaxuan [2 ]
Jing, Zaiping [2 ]
机构
[1] Shanghai Jiao Tong Univ, Shanghai Gen Hosp, Dept Vasc Surg, 650 New Song Jiang Rd, Shanghai 201600, Peoples R China
[2] Navy Med Univ, Changhai Hosp, Dept Vasc Surg, 168 Changhai Rd, Shanghai 200433, Peoples R China
基金
中国国家自然科学基金;
关键词
Branched stent-graft; Chimney technique; Endovascular; Aortic dissection; Aneurysm; IN-SITU FENESTRATION; ENDOVASCULAR REPAIR; SUPRAAORTIC BRANCHES; RECONSTRUCTION; DISSECTION; OUTCOMES; REGISTRY;
D O I
10.1007/s00270-022-03063-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Purpose We compared the mid-term outcomes of a one-piece branched stent-graft with the chimney technique in the treatment of aortic arch pathologies. Methods Between August 2012 and December 2017, a retrospective analysis of 279 patients with thoracic aortic dissection (TAD) or aneurysm (TAA) who underwent thoracic endovascular aortic repair with b-TEVAR (n = 69, 58 TAD and 11 TAA) or c-TEVAR (n = 210, 151 TAD and 59 TAA) was performed. Results Forty-five double-chimney for the left subclavian artery (LSA) and left common carotid artery LCCA and 165 single-chimney for the LSA were performed in chimney-TEVAR (c-TEVAR) and 69 branched-TEVAR (b-TEVAR) with 36 single-branched stent-grafts and 33 branched stent-grafts combined with fenestration technique. The c-TEVAR group experienced more in-hospital complications than the b-TEVAR group (19.5 vs. 7.2%, p = 0.017), primarily because the c-TEVAR group experienced more in-hospital cerebral ischemia events (6.2 vs. 0%, p = 0.043) and intra-operative type I endoleaks (31.9 vs. 5.8%, p < 0.01). There were significantly more follow-up type I endoleaks (21.9 vs. 4.3%, p = 0.002), cerebral ischemia events (11.0 vs. 2.9%, p = 0.042), and re-interventions (12.9 vs. 4.3%, p = 0.048) in the c-TEVAR group than in the b-TEVAR group. However, follow-up mortality was not significantly different between the c-TEVAR and b-TEVAR groups (5.2 vs. 2.9%, p = 0.638). Conclusion In patients with aortic pathologies involving the arch branches, customized b-TEVAR may result in fewer cerebral ischemia events and endoleaks than c-TEVAR. However, c-TEVAR should be considered an off-the-shelf treatment option for patients in need of emergency treatment.
引用
收藏
页码:733 / 743
页数:11
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