Comparison of total percutaneous in situ microneedle puncture and chimney technique for left subclavian artery fenestration in thoracic endovascular aortic repair for type B aortic dissection.

IF 4.7 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING European Radiology Pub Date : 2024-11-01 Epub Date: 2024-05-07 DOI:10.1007/s00330-024-10774-9

Peng Ye, Hongfei Miao, Qingle Zeng, Yong Chen

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Abstract

Objective: To compare the outcomes of totally percutaneous in situ microneedle puncture for left subclavian artery (LSA) fenestration (ISMF) and chimney technique in type B aortic dissection (TBAD) during thoracic endovascular aortic repair (TEVAR).

Materials and methods: Data on patients who underwent either chimney-TEVAR (n = 89) or ISMF-TEVAR (n = 113) from October 2018 to April 2022 were analyzed retrospectively. The primary outcomes were mortality and major complications at 30 days and during follow-up.

Results: The technical success rate was 84.3% in the chimney group and 93.8% in the ISMF group (p = 0.027). The incidence of immediate endoleakage was significantly higher in the chimney than ISMF group (15.7% vs 6.2%, respectively; p = 0.027). The 1- and 3-year survival rates in the chimney and ISMF groups were 98.9% ± 1.1% vs 98.1% ± 0.9% and 86.5% ± 6.3% vs 92.6% ± 4.1%, respectively (log-rank p = 0.715). The 3-year rate of cumulative freedom from branch occlusion in the chimney and ISMF group was 95.4% ± 2.3% vs 100%, respectively (log-rank p = 0.023).

Conclusion: Both ISMF-TEVAR and chimney-TEVAR achieved satisfactory short- and mid-term outcomes for the preservation of the LSA in patients with TBAD. ISMF-TEVAR appears to offer better clinical outcomes with higher patency and lower reintervention rates. However, ISMF-TEVAR had longer operation times with higher procedure expenses.

Clinical relevance statement: When LSA revascularization is required during TEVAR, in situ, fenestration, and chimney techniques are all safe and effective methods; in situ, fenestration-TEVAR appears to offer better clinical outcomes, but takes longer and is more complicated.

Key points: LSA revascularization during TEVAR reduces post-operative complication rates. Both in situ ISMF-TEVAR and chimney-TEVAR are safe and effective techniques for the preservation of the LSA during TEVAR. The chimney technique is associated with a higher incidence of endoleakage and branch occlusion, but ISMF-TEVAR is a more complicated and expensive technique.

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B 型主动脉夹层胸腔内血管主动脉修补术中左锁骨下动脉全经皮原位微针穿刺与烟囱技术的比较

目的比较胸腔内主动脉修复术（TEVAR）中完全经皮原位微针穿刺左锁骨下动脉（LSA）栅栏术（ISMF）和烟囱技术治疗B型主动脉夹层（TBAD）的疗效：回顾性分析了2018年10月至2022年4月期间接受烟囱-TEVAR（n = 89）或ISMF-TEVAR（n = 113）的患者数据。主要结果是30天和随访期间的死亡率和主要并发症：烟囱组的技术成功率为84.3%，ISMF组为93.8%（P = 0.027）。烟囱组的即刻内漏发生率明显高于 ISMF 组（分别为 15.7% 对 6.2%；P = 0.027）。烟囱组和 ISMF 组的 1 年和 3 年存活率分别为 98.9% ± 1.1% vs 98.1% ± 0.9% 和 86.5% ± 6.3% vs 92.6% ± 4.1%（log-rank p = 0.715）。烟囱组和ISMF组3年累计无分支闭塞率分别为95.4% ± 2.3% vs 100%（log-rank p = 0.023）：结论：ISMF-TEVAR 和烟囱-TEVAR 在保留 TBAD 患者 LSA 方面都取得了令人满意的短期和中期结果。ISMF-TEVAR似乎具有更好的临床效果，通畅率更高，再介入率更低。然而，ISMF-TEVAR的手术时间更长，手术费用更高：临床相关性声明：当 TEVAR 期间需要进行 LSA 血管再通时，原位、栅栏和烟囱技术都是安全有效的方法；原位、栅栏-TEVAR 似乎能提供更好的临床疗效，但手术时间更长、更复杂：要点：TEVAR术中的LSA血管再通可降低术后并发症发生率。原位 ISMF-TEVAR 和烟囱-TEVAR 都是 TEVAR 期间保留 LSA 的安全有效技术。烟囱技术与较高的内漏和分支闭塞发生率相关，但 ISMF-TEVAR 是一种更复杂、更昂贵的技术。

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来源期刊

European Radiology 医学-核医学

CiteScore

11.60

自引率

8.50%

发文量

874

审稿时长

2-4 weeks

期刊介绍： European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.