胸主动脉疾病左锁骨下动脉切开与血管内分离的早期和中期结果

IF 1.1 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic and Cardiovascular Surgery Pub Date : 2022-06-20 Epub Date: 2021-12-22 DOI:10.5761/atcs.oa.21-00206
Philip Dueppers, Lorenz Meuli, Benedikt Reutersberg, Michael Hofmann, Florian Messmer, Alexander Zimmermann
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引用次数: 5

摘要

目的:比较开放与血管内左锁骨下动脉去分支在胸主动脉病变的血管内主动脉修复中的应用。方法:回顾性研究2009年10月至2020年1月在我院接受左锁骨下动脉去分支手术的患者。主要结局是主动脉再介入的自由。次要结局是I型内漏、左锁骨下动脉(LSA)去分支失败、中风、技术或临床成功、手术相关的再干预,以及30天或总体全因死亡率和主动脉相关死亡率。结果:48例患者接受平行移植(n = 24, ENDO;中位年龄75岁[70-80岁])或open (n = 24, open;中位年龄71岁[59-75岁]),因B型主动脉夹层(n = 25)、退行性动脉瘤(n = 12)、IA型内漏(n = 6)、缝合线相关(n = 3)或口部LSA动脉瘤(n = 1)或穿透性主动脉溃疡(n = 1)进行去分支手术。中位随访时间为36个月(13-61个月)。16个月后,OPEN组和ENDO组无主动脉再介入生存率分别为91%(95%可信区间[CI]: 79 ~ 100%)和86% (73 ~ 100%)(p = 0.71)。36个月后,OPEN组和ENDO组的全因生存率分别为74% (95% CI: 55 ~ 99%)和79% (95% CI: 64 ~ 97%) (p = 0.74);无主动脉相关死亡率分别为81% (95% CI: 62 ~ 100%)和91% (95% CI: 80 ~ 100%) (p = 0.78)。OPEN组出现较少I型内漏(OPEN/ENDO = 3/19, p)。结论:两种策略的再干预率和死亡率相当,但开放式去分支术因其较高的技术和临床成功率以及较少的I型内漏而应首选。
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Early and Mid-Term Outcomes of Open versus Endovascular Left Subclavian Artery Debranching for Thoracic Aortic Diseases.

Purpose: To compare open versus endovascular left subclavian artery debranching for thoracic endovascular aortic repair of thoracic aortic pathologies.

Methods: This is a retrospective study of patients receiving left subclavian artery debranching in our institution from October 2009 to January 2020. The primary outcome was freedom from aortic reintervention. Secondary outcomes were type I endoleaks, left subclavian artery (LSA) debranching failure, stroke, technical or clinical success, procedure-related reintervention, as well as 30-day or overall all-cause and aorta-related mortality.

Results: Forty-eight patients received parallel graft-based (n = 24, ENDO; median age 75 years [70-80 years]) or open (n = 24, OPEN; median age 71 years [59-75 years]) debranching for type B aortic dissection (n = 25), degenerative aneurysm (n = 12), type IA endoleak (n = 6), suture-associated (n = 3) or ostial LSA aneurysm (n = 1), or penetrating aortic ulcer (n = 1). The median follow-up was 36 months (13-61 months). After 16 months, aortic reintervention-free survival in groups OPEN and ENDO was 91% (95% confidence interval [CI]: 79 to 100%) and 86% (73 to 100%) (p = 0.71), respectively. After 36 months, all-cause survival in groups OPEN and ENDO was 74% (95% CI: 55 to 99%) and 79% (95% CI: 64 to 97%) (p = 0.74), respectively; freedom from aorta-related mortality was 81% (95% CI: 62 to 100%) and 91% (95% CI: 80 to 100%) (p = 0.78), respectively. Group OPEN presented less type I endoleaks (OPEN/ENDO = 3/19, p <0.001) and higher technical (OPEN/ENDO = 81/36%, p = 0.003) and clinical success rates (OPEN/ENDO = 67/36%, p = 0.047). No statistical differences were found for other outcomes.

Conclusion: Both strategies achieved comparable reintervention and mortality rates, but open debranching should be preferred due to its higher technical and clinical success and less type I endoleaks.

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来源期刊
Annals of Thoracic and Cardiovascular Surgery
Annals of Thoracic and Cardiovascular Surgery CARDIAC & CARDIOVASCULAR SYSTEMS-SURGERY
CiteScore
2.80
自引率
0.00%
发文量
56
审稿时长
4-8 weeks
期刊介绍: Information not localized
期刊最新文献
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