1、主动脉弓复杂病变主动脉弓复杂病变 Hybrid,Chimney or else?贾鑫、郭伟贾鑫、郭伟Vascular and Endovascular Surgery DepartmentChinese PLA General Hospitalu Endovascular Chimney Fenestration Branched Stent-graftCriado et al,J Endovasc Ther 2019累及主动脉弓病变可采用技术u Hybrid approach Cervical-thoracic Debranching Hybrid Procedures ResearchNo
2、.Landing ZoneZ0/Z1/Z2SuccessMortalityStrokeParaplegiaEndoleakHughes 20198748/19/0955.74.639Lotfi 20195148/19/0-1012616Vallejo 20193827/11/097.423.713.12.710.5Melissano 201914332/35/7690.94.92.8-8.4Ye 20194510/4/10/2197.86.76.7022.2Geisbusch 20194715/23/9-196.3614.9Guo 2019255/12/89842011Weruman 2009
3、2626/0/01001540-Chaevel 2019165/8/3810190-杂交技术文献分析Landing zoneNo.of patientsPrimary technical successReinterventionsIn-hospital mortalityInitial clinical successLate mortalityZone 0130120（95.2%）12(12%)11（8.5%）111（88.1%）0Zone 113170（83.3%）16(25.8%)6（4.6%）71（84.5%）2Total261190（90.5%）28（17.3%）17（6.5%）1
4、82（86.7%）2P value0.00690.03210.220.530.16Odds ratio42.551.931.35N/AKotelis D,et al.Total vs hemi-aortic arch transposition for hybrid aortic arch repair.J Vasc Surg.2019;54(4):1182-1186.Meta-analysisLanding zoneNo.of patientsStrokeSpinal cord injuryType I endoleakType II endoleakZone 01304(3.2%)1(0.
5、8%)5(4%)10(10%)Zone 11315(4.2%)3(2.3%)13(15.5%)8(12.9%)Total2619(3.7%)4(1.5%)18(8.6%)18(11.1%)P value0.740.620.0050.61Odds ratio0.750.334.430.75Kotelis D,et al.Total vs hemi-aortic arch transposition for hybrid aortic arch repair.J Vasc Surg.2019;54(4):1182-1186.Meta-analysis In-hospital mortality i
6、s relatively low(6.5%),neurological complications near 5%.Endoleak rate is also low(8.6%for type I/III).Limited number,need large volume and long-term follow-up主动脉弓杂交手术临床证据Chimney Technique 烟囱技术临床证据烟囱技术临床证据sourcesTechnical success Perioperative mortality(all-cause)Perioperative morbidityEndoleakStro
7、keLarzon et al,20191/2(50%)0/2(0%)0/2(0%)2/2(100%)0/2(0%)Criado et al,20198/8(100%)0/8(0%)0/8(0%)0/8(0%)0/8(0%)Baldwin et al,20196/7(85.7%)0/7(0%)1/7(14.1%)2/7(28.5%)1/7(14.2%)Ohrlander,et al,20193/4(75%)0/4(0%)1/4(25%)2/4(50%)1/4(25%)Sugiura,et al,20099/11(81.8%)2/11(18.1%)a3/11(27.2%)2/11(18.2%)1/
8、11(9.1)Cires et al,20199/9(100%)1/9(11/1%)2/9(22.2%)1/9(11.1%)1/9(11.1%)Yoshida et al,20192/2(100%)0/2(0%)0/2(0%)0/2(0%)0/2(0%)Sue et al,20198/8(100%)0/8(0%)0/8(0%)2/8(25%)0/8(0%)No.of patients(vessels)Landing zone(Z0/Z1/Z2)Technical successStrokeI EndoleakChimney grafts patentcy94(101)20/48/33 98%5
9、.3%18%100%Hogendoorn w,et al Thoracic endovascular aortic repair with the chimney graft technique.J Vasc Surg.2019:May19,S0741-745.Meta-analysis of clinical outcomes with chimney烟囱技术临床证据 Overall perioperative mortality(3.2%)Morbidity rate(stroke rate 5.3%)Graft patency(100%)All comparable to hybrid
10、series.Hogendoorn w,et al Thoracic endovascular aortic repair with the chimney graft technique.J Vasc Surg.2019:May19,S0741-745.All the chimney stents were off label use,the sample number small,most less than 10 cases.Relative new,with a median follow-up of 11 months与杂交手术证据相比，烟囱技术问题1 Hogendoorn w,et
11、 al Thoracic endovascular aortic repair with the chimney graft technique.J Vasc Surg.2019:May19,S0741-745.In chimney seris,nearly 1/3 in Zone 2,the type I endoleak rate was 18%1.The higher rate of endoleaks when the BCA or LCCA are stented compared with the LSA only(30%and 27%vs 9.1%).与杂交手术证据相比，烟囱技术
12、问题 Hogendoorn w,et al Thoracic endovascular aortic repair with the chimney graft technique.J Vasc Surg.2019:May19,S0741-745.J Vas Surg.2019,June:57(6):1664-67 Lioupis C,et al.Euro J Vas Endovas Surg.2019,May,525-32 TAA Involving LSA and LCCA Fenestration in situWith home-made endo-shuntsCutting Ball
13、oonFenestration in situ of LCCA and LSAConclusionsl Hybrid procedure well proved and could be used in most cases at present time.l Chimney grafts should only be used in specific cases(eg.high surgical risk,Zone 2).l Fenestration and branched grafts need further investigation.Thanks Thanks for your attentionfor your attention谢谢
