Thoracic endovascular aortic repair for degenerative distal arch aneurysm can be used as a standard procedure in high-risk patients

被引:25
作者
Shijo, Takayuki [1 ]
Kuratani, Toru [2 ]
Torikai, Kei [1 ]
Shimamura, Kazuo [1 ]
Sakamoto, Tomohiko [1 ]
Kudo, Tomoaki [2 ]
Masada, Kenta [1 ]
Takahara, Mitsuyoshi [3 ]
Sawa, Yoshiki [1 ]
机构
[1] Osaka Univ, Grad Sch Med, Dept Cardiovasc Surg, Osaka, Japan
[2] Osaka Univ, Grad Sch Med, Dept Minimally Invas Cardiovasc Med, Osaka, Japan
[3] Osaka Univ, Grad Sch Med, Dept Diabet Care Med, Osaka, Japan
关键词
Supra-aortic rerouting; Thoracic endovascular aortic repair; Stroke; LEFT SUBCLAVIAN ARTERY; PERIOPERATIVE STROKE; REPLACEMENT; MORTALITY; COVERAGE; TEVAR;
D O I
10.1093/ejcts/ezw020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
In recent years, supra-aortic rerouting and thoracic endovascular aortic repair (TEVAR) for treating aortic arch pathology have emerged as a less invasive option for high-risk patients. This study aimed to assess our strategy for preventing stroke and improving late outcomes after supra-aortic rerouting and TEVAR. Between July 2008 and July 2015, we performed 280 cases of TEVAR for arch pathologies, using manufactured stent grafts. This study reviewed 101 patients who underwent supra-aortic rerouting and TEVAR for degenerative distal arch aneurysms (80 men, mean age 73.1 years, Zone 1/Zone 2 = 48/53). Since 2011, we have routinely used the brain protection method, which comprises blocking native forward flow from the left common carotid artery (LCA) and left subclavian artery (LSA) for zone 1 cases and the LSA for zone 2 cases before TEVAR. The mean operation time was 178 +/- 65 min. The stroke and 30-day death rates were 3 and 1%, respectively. Before the brain protection method was introduced, the perioperative risk factor for stroke was atheroma Grade a parts per thousand yenIII (P = 0.035). Proximal landing zone (P = 0.58) and LSA sacrifice (P = 1.00) were not risk factors for stroke. No strokes occurred after using the brain protection method (before protection: 6% and after protection: 0%). Regarding late results, the rate of freedom from aorta-related death at 1 and 4 years was 97 and 95%, respectively. The rate of freedom from aortic events at 1 and 4 years was 91 and 86%, respectively. During follow-up, no type Ia endoleak developed and one type A dissection was observed. Our strategy for supra-aortic rerouting and TEVAR showed satisfactory early and late results. The chief risk factor for perioperative stroke was atheroma, and blocking native forward flow from the LCA and the LSA prior to the TEVAR procedure helped prevent stroke.
引用
收藏
页码:257 / 263
页数:7
相关论文
共 26 条
  • [1] Transcranial Doppler findings during thoracic endovascular aortic repair
    Bismuth, Jean
    Garami, Zsolt
    Anaya-Ayala, Javier E.
    Naoum, Joseph J.
    El Sayed, Hosam F.
    Peden, Eric K.
    Lumsden, Alan B.
    Davies, Mark G.
    [J]. JOURNAL OF VASCULAR SURGERY, 2011, 54 (02) : 364 - 369
  • [2] Buth J, 1998, J ENDOVASC SURG, V5, P329, DOI 10.1583/1074-6218(1998)005<0329:CATSGT>2.0.CO
  • [3] 2
  • [4] Reporting standards for endovascular aortic aneurysm repair
    Chaikof, EL
    Blankensteijn, JD
    Harris, PL
    White, GH
    Zarins, CK
    Bernhard, VM
    Matsumura, JS
    May, J
    Veith, FJ
    Fillinger, MF
    Rutherford, RB
    Kent, KC
    [J]. JOURNAL OF VASCULAR SURGERY, 2002, 35 (05) : 1048 - 1060
  • [5] Results after endovascular stent graft placement in atherosclerotic aneurysms involving the descending aorta
    Czerny, Martin
    Grimm, Michael
    Zimpfer, Daniel
    Rodler, Suzanne
    Gottardi, Roman
    Hutschala, Doris
    Lammer, Johannes
    Wolner, Ernst
    Schoder, Maria
    [J]. ANNALS OF THORACIC SURGERY, 2007, 83 (02) : 450 - 455
  • [6] Aortic arch debranching and thoracic endovascular repair
    De Rango, Paola
    Cao, Piergiorgio
    Ferrer, Ciro
    Simonte, Gioele
    Coscarella, Carlo
    Cieri, Enrico
    Pogany, Gabriele
    Verzini, Fabio
    [J]. JOURNAL OF VASCULAR SURGERY, 2014, 59 (01) : 107 - 114
  • [7] Feezor RJ, 2007, J ENDOVASC THER, V14, P568, DOI 10.1583/1545-1550(2007)14[568:RFFPSD]2.0.CO
  • [8] 2
  • [9] Risk factors for perioperative stroke after thoracic endovascular aortic repair
    Gutsche, Jacob T.
    Cheung, Albert T.
    McGarvey, Michael L.
    Moser, William G.
    Szeto, Wilson
    Carpenter, Jeffrey P.
    Fairman, Ronald M.
    Pochettino, Alberto
    Bavaria, Joseph E.
    [J]. ANNALS OF THORACIC SURGERY, 2007, 84 (04) : 1195 - 1200
  • [10] Ishimaru S, 2004, J ENDOVASC THER, V11, P62