Surgical treatment of an aortic arch aneurysm without cardio-pulmonary bypass: endovascular stent-grafting after extra-anatomic bypass of supra-aortic vessels.

A 70-year-old patient presented a large saccular aneurysm involving the whole aortic arch. Because of a past history of left thoracotomy and a high co-morbidity profile, we opted for a combined strategy, consisting of an extra-anatomic bypass of the supra-aortic vessels, followed by the endovascular implantation of a covered thoracic stent-graft. Endovascular stent grafting of aortic arch aneurysm, after extra anatomic bypass of supra-aortic vessels, appears as an attractive alternative strategy for high surgical risk patients.     

Double-chimney technology for treating secondary type I endoleak after endovascular repair for complicated thoracic aortic dissection

Endovascular repair continues to pose a formidable technical challenge in the cases of aneurysm, dissection, and proximal type I endoleak involving the aortic arch. During the process of covering the aortic arch by stent graft to achieve better sealing, maintaining blood flow to the vital supra-aortic branches is difficult. We present a case of successful endovascular treatment of secondary type I endoleak by a double-chimney technique in a 36-year-old woman who had previously undergone a complicated descending aortic dissection repair. This endovascular technology might offer a new option to simultaneously preserve the innominate artery and the left carotid artery for total reconstruction of the aortic arch.     

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??Chimney technique for aortic diseases involving supra-aortic branches in a single center SHU Chang, WANG Tun. Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha 410011, China
Corresponding author: SHU Chang, E-mail??changshu01@yahoo.com
Abstract Objective To evaluate the mid- and long-term efficiency of thoracic endovascular aortic repair (TEVAR) with chimney technique for aortic arch disease involving the supra-aortic branches. Methods The clinical data of 57 cases of aortic arch diseases performed TEVAR with chimney technique from September 2009 to December 2013 in Department of Vascular Surgery, the Second Xiangya Hospital, Central South University were analyzed retrospectively. There were 2 cases (3.5%) of aortic arch aneurysm, 1 case (1.8%) of type I endoleak after TEVAR for thoracic aortic aneurysm, 1 case (1.8%) of type I endoleak after TEVAR for type B aortic dissection (TBAD), 53 cases (92.9%) of TBAD. One case was complicated with Marfan syndrome. Results All of the stent grafts were deployed as planned. Five cases had type II endoleak during TEVAR. One case received re-TEVAR and another chimney stent grafts deployment because of ischemia of branch arteries caused by migration of chimney stent grafts during anesthesia resuscitation. All patients followed up for 2 to 51 months. One case of TBAD received re-TEVAR for distal re-entry. One case died of cerebral hemorrhage 3 months later. No TEVAR related complications happened, such as stent graft migration, occlusion, fracture or type I endoleak during follow-up. Conclusion Chimney technique can be used with TEVAR to treat aortic arch disease invaded supra-aortic branches, which is reliable and stable. Reconstructed supra-aortic branches with covered stent is useful for prevention of post-TEVAR complications     

Hybrid approach to complex thoracic aortic aneurysms in high-risk patients: surgical challenges and clinical outcomes

BACKGROUND: Endovascular therapy is a less invasive alternative treatment for high-risk patients with thoracic aortic aneurysms. However, this technology alone is often not applicable to complex aneurysmal morphology. The purpose of this study was to evaluate the utility of hybrid strategies in high-risk patients who are otherwise unsuitable for endovascular therapy alone. METHODS: During an 18-month period, 31 high-risk patients (mean age, 69 years; range, 52-89 years) underwent combined open and endovascular approaches for complex aneurysms, including 16 patients with ascending and arch aneurysms and 15 patients with aneurysms involving visceral vessels. Among them, 11 patients had histories of aneurysm repairs. To overcome the anatomic limitations of endovascular repairs, various adjunctive surgical maneuvers were used, including aortic arch reconstruction in 3 patients, supra-aortic trunk debranching in 13 patients (including 8 patients who required aortas as inflow sources), and visceral vessel bypasses in 15 patients (including 10 patients who required bypasses to all 3 visceral branches). Additionally, carotid artery access was obtained in 1 patient, and iliac artery conduits were created in 12 patients. RESULTS: Technical success was achieved in all patients. There was one perioperative death (3.2%) due to postoperative bleeding. Two patients (6.4%) had immediate type II endoleaks, which were resolved by the 1-month follow-up. Other procedure-related complications occurred in three patients (9.6%), including renal bypass thromboses in two patients and retroperitoneal hematoma, which was successfully managed conservatively, in one patient. During a mean follow-up of 16 months, two patients died of unrelated causes, whereas the remainder of patients were asymptomatic, without aneurysm enlargement. CONCLUSIONS: Our study highlights how hybrid strategies incorporating surgical and endovascular approaches can be used successfully in treating patients with complex thoracic aortic aneurysms. This combined approach potentially expands the field of endovascular stent grafting and is an attractive solution for patients with poor cardiopulmonary reserves.     

Acute Type A Dissection Treated with Combined Endovascular Repair of Arch and Surgical Bypass of Arch Vessels from Descending Aorta

We report a case of an endovascular repair of a recurrent dissecting aneurysm of the aortic arch and dissection of carotid vessels, 3 years after surgical repair of aortic valve and ascending aorta for a type A dissection. We performed a bypass from the descending aorta to right, left common carotid artery (CCA), to left subclavian artery with no cardiopulmonary bypass and thereafter, total ascending and aortic arch stent grafting. We suggest considering total aortic arch stent grafting with bypass of arch vessels in cases of complicated acute type A dissection. In cases where the ascending aorta cannot be used as donor site for bypass, we suggest the use of the descending aorta.     

经颈动脉腔内技术重建主动脉弓治疗Stanford A型夹层动脉瘤(附1例报告)

目的探讨血管腔内技术重建主动脉弓治疗升主动脉、主动脉弓病变的可行性。方法2005年,对1例StanfordA型夹层动脉瘤,腔内修复主动脉病变之前做右颈总动脉-左颈总动脉-左锁骨下动脉的旁路术;经右颈总动脉将修改的分叉支架型血管主体放入升主动脉,长臂位于无名动脉。短臂应用延长支架型血管延伸至降主动脉。通过腔内技术重建主动脉弓实现累及升主动脉和主动脉弓主动脉病变的微创治疗。结果腔内修复术后移植物形态良好,血流通畅,病变被隔绝,脑、躯干、四肢循环稳定。无严重并发症。结论该手术方案设计合理、技术可行。可能成为复杂胸主动脉病变新的腔内治疗模式。     

Ankura主动脉覆膜支架行原位开窗重建弓上分支的应用

背景与目的 胸主动脉腔内修复术（TEVAR）已经成为治疗主动脉弓部病变的首选术式。然而,此术式要求支架近端安全锚定区至少为15 mm,对于锚定区不足者,则通常需重建弓部分支血管以确保手术安全。在目前各种重建技术中,原位开窗技术因其较大程度的保留分支血管以及较低的内漏风险而应用最多。因此,本研究探讨Ankura主动脉覆膜支架进行原位开窗重建弓上分支的可行性及效果。方法 回顾性分析2017年3月—2020年12月中国科学院大学宁波华美医院收治的47例近端锚定区不足的主动脉病变患者的临床资料。其中胸主动脉夹层38例,胸主动脉瘤6例,胸主动脉溃疡3例。根据术前CTA影像资料决定患者的开窗数目、开窗支架规格,术中利用穿刺针对Ankura主动脉覆膜支架进行原位开窗重建弓部分支,术后定期行主动脉CTA复查随访。结果 所有患者均获手术成功,共植入Ankura胸主动脉覆膜支架47枚,Gore Viabahn覆膜支架51枚,Cordis Smart裸支架20枚。4例术中转烟囱支架植入,原位开窗成功率91.5%（43/47）,包括左锁骨下动脉（LSA）开窗29例,左颈总动脉（LCCA）开窗+LSA栓塞1例,LSA开窗+左椎动脉烟囱1例,LSA开窗+左LCCA烟囱9例,LCCA+LSA开窗+无名动脉（IA）烟囱1例,LCCA开窗+IA烟囱+LSA栓塞2例。全组患者手术时间160~300 min,平均（200±20）min,术中开窗时间18~45 min,平均（30±8）min;术后内漏（1型）3例,逆撕2例（1例行升主动脉置换后好转,1例死亡）,脑梗死2例,截瘫0例。平均随访时间（28.4±14.7）个月,期间2例内漏在随访中消失,1例内漏未进一步增大予以观察随访中,未见开窗分支血管闭塞。结论 利用穿刺破膜技术对Ankura主动脉覆膜支架进行原位开窗重建分支血管是一种切实可行且有效的治疗方式,近期效果良好。     

Early and mid-term results of endovascular stent grafting for aortic aneurysms]

Early and mid-term clinical results of 28 cases of endovascular stent grafting for descending thoracic aortic aneurysms and 11 cases of abdominal aortic aneurysms are reported. Early clinical results: Among 28 patients (7 true thoracic aortic aneurysms, 3 pseudothoracic aortic aneurysms and 8 acute, 4 subacute, and 6 chronic aortic dissections), two patients (7.1%) with ruptured acute aortic dissection or ruptured infected pseudoaneurysm died in the perioperative period. Two of the remaining 26 patients experienced minor complications. Aneurysmal sacs or false lumens at the descending thoracic aorta were completely thrombosed in the 26 patients. One patient (9.1%) with a ruptured abdominal aneurysm died, and one of the remaining 10 patients had renal and peripheral emboli and peripheral vascular trauma. Inadvertent covering of the renal arteries occurred in another patient. Unless one patient had persistent endoleak, aneurysmal sacs in the 10 surviving patients were thrombosed. Mid-term clinical results: One aortic dissection at a different section of the descending aorta occurred 6 months after stent grafting for aortic dissection, and one patient died of pneumonia 3 months after stent grafting for an abdominal aortic aneurysm. CT scanning 6 months after stent grafting revealed a decrease in maximal aneurysmal size in 3 of 9 patients with true or pseudothoracic aneurysms and in 2 of 5 patients with abdominal aortic aneurysms. Five of 9 patients with stent grafting for acute or subacute dissection showed elimination of the false lumen in the descending thoracic aorta in a CT scan 6 months after grafting. One patient with a true thoracic aneurysm and one patient with an abdominal aortic aneurysm showed an increase in aneurysmal size in a CT scan 2 years and one year after treatment, respectively.     

Hybrid repair of an aortic arch aneurysm with complex anatomy: right aortic arch and anomalous origin of supra-aortic vessels

We performed a one-stage hybrid surgical and endovascular procedure to manage a 6.5-cm right aortic arch aneurysm associated with anomalous origin of the supra-aortic vessels in a 70-year-old man. Complete surgical rerouting of the supra-aortic vessels was followed by the endovascular repair of the right aortic arch aneurysm with a Zenith TX2 stent graft (Cook, Bloomington, Ind) and Z-track plus introducer system. The procedure was successfully completed with exclusion of the aortic arch aneurysm, and the patient was discharged on postoperative day 7. Aortic arch aneurysms with complex anatomy may be successfully treated with a less invasive hybrid approach using new generation devices.     

Coverage of the left subclavian artery during thoracic endovascular aortic repair

BACKGROUND: Thoracic aortic stent grafts require proximal and distal landing zones of adequate length to effectively exclude thoracic aortic lesions. The origins of the left subclavian artery and other aortic arch branch vessels often impose limitations on the proximal landing zone, thereby disallowing endovascular repair of more proximal thoracic lesions. METHODS: Between October 2000 and November 2005, 112 patients received stent grafts to treat lesions involving the thoracic aorta. The proximal aspect of the stent graft partially or totally occluded the origin of at least one great vessel in 28 patients (25%). The proximal attachment site was in zone 0 in one patient (3.6%), zone 1 in three patients (10.7%), and zone 2 in 24 patients (85.7%). Patients with proximal implantation in zones 0 or 1 underwent debranching procedures of the supra-aortic vessels before stent graft repair. In one patient who underwent zone 1 deployment, the left subclavian artery was revascularized before stent graft deployment. Among patients who underwent zone 2 deployment with partial or complete occlusion of the left subclavian artery, none underwent prior revascularization. Patients were assessed postoperatively and at follow-up for development of neurologic symptoms as well as symptoms of left upper extremity claudication or ischemia. RESULTS: Mean follow-up was 7.3 months. Among the 24 patients with zone 2 implantation, 10 (42%) had partial left subclavian artery coverage at the time of their primary procedure. A total of 19 patients experienced complete cessation of antegrade flow through the origin of the left subclavian artery without revascularization at the time of the initial endograft repair as a result of a secondary procedure or as a consequence of left subclavian artery thrombosis. Left upper extremity symptoms developed in three (15.8%) patients that did not warrant intervention, and rest pain developed in one (5.3%), which was treated with the deployment of a left subclavian artery stent. Two primary (type IA and type III) endoleaks (7.1%) and one secondary endoleak (type IA) (3.6%) were observed in patients who underwent zone 2 deployment. Three cerebrovascular accidents were observed. Thoracic aortic lesions were successfully excluded in all patients who underwent supra-aortic debranching procedures. CONCLUSION: Intentional coverage of the origin of the left subclavian artery to obtain an adequate proximal landing zone during endovascular repair of thoracic aortic lesions is well tolerated and may be managed expectantly, with some exceptions.     

Hybrid aortic procedures for endoluminal arch replacement in thoracic aneurysms and type B dissections

The aim of this study was to report our clinical experience with and review current literature on endoluminal aortic hybrid techniques and to evaluate outcome in high-risk patients treated for complex aortic arch lesions combining conventional supra-aortic debranching bypasses with subsequent or staged thoracic endovascular grafting. Of 172 patients treated with thoracic endografts for different thoracic aortic pathologies within the last 8 years, the mid-aortic arch was involved in 25, i.e. at least the left common carotid artery had to be overstented and revascularized to provide a proper proximal landing zone. These debranching bypasses were performed as a simultaneous or a staged procedure. All patients were at high-risk and were excluded by cardiac surgeons as ineligible for conventional arch repair. After partial (n=16) or complete (n=9) supra-aortic transposition, 4 different commercially available endografts (80% TAG, WL Gore) were implanted transfemorally or via iliac conduit. Deployment success was 100% in 25 patients after simultaneous or staged supra-aortic transposition; in 32% an emergency procedure was performed due to contained rupture; in 36% more than 1 endograft system was implanted (2 in 20%, 3 in 8% und 4 in 8%). The overall perioperative thirty-day mortality was 5 of 25 (20%) due to interoperative proximal bare stent perforation (n=1), transfusion related acute lung injury (TRALI n=1), cardiac failure (n=1), embolic stroke (n=1) and pneumonia (n=1). The mean follow-up was 21 months. All endoleaks type I (n=3) were corrected with another endograft; the 2 endoleaks type II sealed spontaneously. The major adverse events were: prolonged ventilation in 5 (20%), temporary renal insufficiency with hemodialysis (n=2), bypass infection (n=1), without any complications (n=9). No cases of paraplegia were recorded. Hybrid aortic arch repair is technically challenging but feasible. This novel approach may be an alternative to standard open procedures in high-risk patients and emergency cases. However, the promising early results need to be confirmed by longer follow-up and larger series.     

胸主动脉瘤及主动脉夹层外科治疗进展

胸主动脉瘤及主动脉夹层病情凶险，死亡率和病残率均很高。近几年在保留和不保留主动脉瓣的主动脉根重建术治疗升主动脉瘤，弓部主动脉瘤切除与脑保护，胸主动脉瘤或胸腹主动脉瘤切除与脊髓保护，以及主动脉腔内支架移植术等方面取得了较大的进展。手术死亡率已从31．4％下降至3．3％－4．8％。胸主动脉瘤，特别是主动脉夹层系一全身性主动脉病变，近年来手术疗效有所改善，但远期复发率和再手术率仍较高。主动脉内支架移植与外科手术结合应用，对复杂的伴有降主动脉病变的A型主动脉夹层治疗，可能是一种安全而有效的方法。     

主动脉腔内修复术后中远期并发症与二次处理策略

目的探讨主动脉腔内修复术后中远期并发症的处理方法与效果。方法1999年5月至2007年6月对21例主动脉病变腔内修复术后中远期并发症进行了再次处理。其中腹主动脉瘤（AAA）15例,胸主动脉动脉瘤（TAA）3例,主动脉夹层（TAD）3例。并发症：Ⅰ型内漏11例,Ⅱ型内漏4例,Ⅲ型内漏2例;移植物阻塞4例。应用延长支架型血管技术处理Ⅰ、Ⅲ型内漏（6例）,应用“侧孔”、“凹口”、“分叉”支架型血管结合颈部血管旁路手术重建主动脉弓处理Ⅰ型内漏（3例）,应用栓塞技术处理Ⅱ型内漏（4例）,应用取栓和旁路手术技术处理移植物阻塞（4例）,应用开放手术技术处理动脉瘤破裂（1例）。结果20例（95．2％）应用腔内技术作为二次处理主要手段,二次处理30d内死亡1例（4．7％）,因技术需要而修改器材结构者3例。二次术后仍存在内漏者5例（29．4％,5／17）。二次干预瘤体相关性死亡3例（14．3％）。结论内漏和移植物阻塞是腔内修复术后主要中远期并发症,其主要原因是原发性内漏的延续和移植物移位。腔内技术可作为二次处理的主要手段。主动脉弓部病变进行二次干预有更大的挑战性。     

Complications]

Transluminal endovascular stent grafts placement has recently been introduced as a promising alternative to surgical treatment of aortic aneurysms, but complications can occur. Mortality, aneurysm rupture, massive microembolization, paraplegia, endoleaks, and graft migration are significant problems associated with endovascular aneurysm repair. An endoleak, defined as persistence of blood flow within the aneurysm sac outside the lumen of the stent graft, is among the most common complications and is a major problem because it may permit aneurysm expansion and rupture. Endoleaks are caused by inadequate hemostatic sealing at the proximal or distal attachment site or by retrograde sac perfusion through patent aortic branch vessels; the reported incidence varies from 10-40%. In the treatment of thoracic aortic aneurysms, the occurrence of paraplegia is considered to be the Achilles heel of this technique, because reconstruction of intercostal arteries is impossible. Coverage of the intercostal artery, which is thought to be important for distal spinal cord blood supply, with stent grafts should be avoided. Although we consider this exciting new technique holds great promise for aortic aneurysm repair, further advances in device technology are necessary to minimize the risk of complications with this procedure.     

降主动脉瘤的腔内移植物治疗

目的 探讨腔内移植物治疗降主动脉瘤的可行性。方法 12例降主动脉瘤接受了血管腔内技术治疗,包括5例真性动脉瘤、6例Stanford B型夹层动脉瘤及1例假性动脉瘤。13枚支架型血管在局部（n=2)或全身麻醉（n=10)下经一侧股动脉切开安装在病变部位。结果 腔内技术成功率100％。无瘤体破裂、截瘫、脏器及肢体缺血等并发症。早期并发症：3例早期内漏血。CT及MRA随访1－30个月：5例真性动脉瘤4例被完全旷置,1例内漏转化为持续性。6例Stanford B型夹层入口4例一期封堵满意,2例少量内漏血自愈,4例假腔内完全血栓形成2,例部分形成。1例假性动脉瘤效果满意。结论 腔内移植物治疗降主动脉瘤是一种安全、可靠、实用的新方法。但其远期治疗效果有待继续观察,尤其是夹层动脉瘤的腔内治疗具有更多的不确定性。     

Secondary elephant trunk fixation with endovascular stent grafting for extensive/multiple thoracic aortic aneurysm.

Four patients who underwent secondary elephant trunk fixation by endovascular stent grafting are presented and the advantage of this method to treat multiple/extensive thoracic aortic aneurysm is discussed. In two of them, the elephant trunk installation has been performed at another hospital for extensive aortic aneurysm. In two other patients, the aortic arch replacement and the elephant trunk installation were performed through median sternotomy, initially for multiple aortic lesions, including both arch and descending aorta. No neurological deficit, stroke nor spinal cord injury was encountered during the follow-up period (24-40 months). The diameter of the aneurysms decreased markedly in three patients. In one patient, the aneurysm expanded gradually and type II endoleak was treated by coil embolization. In one patient, who showed marked shrinkage of the aneurysm, the stent graft kinked mildly. Based on the low mortality rate of well-established aortic arch surgery, concomitant elephant trunk installation which was followed by the secondary fixation with endovascular stent grafting might be useful to treat multiple/extensive thoracic aneurysm from distal arch to descending aorta.     

"烟囱"技术在主动脉弓病变腔内修复术中的应用

目的 探讨"烟囱"技术在主动脉弓腔内修复术中应用的可行性.方法 针对近端锚定区偏短的主动脉弓病变,在腔内修复过程中先覆盖重要主动脉弓分支血管,然后通过腔内技术在被覆盖的分支血管内行"烟囱"支架置入术.回顾性统计2004年8月至2009年8月应用"烟囱"技术处理病变的临床资料,分析应用"烟囱"技术的原因、方法、结果和并发症状况等.结果 本组共27例主动脉弓病变腔内修复技术中应用了"烟囱"技术,男性25例,女性2例.年龄37～84岁,平均(67.2±3.8)岁.针对无名动脉的"烟囱"技术3例,针对左颈总动脉的"烟囱"技术11例,针对左锁骨下动脉的"烟囱"技术13例.5例术后即刻造影提示存在少量I型内漏(18.5%).1例术中因左颈总动脉穿刺造成了该动脉夹层.1例术后因呼吸衰竭死亡.无中风、出血等并发症发生.随访时间3～60个月,平均(16.8±5.9)个月.1例次要脑梗死,1例"烟囱"支架闭塞.1例术后4年因心肌梗死死亡.所有I型内漏均消失,无支架型血管和"烟囱"支架移位等并发症.结论 "烟囱"技术有效提高了锚定区长度,能很好的降低I型内漏的发生率.但应严格选择适应证,防止可能带来的并发症.     

Endovascular treatment of aortic arch aneurysms.

INTRODUCTION: The aim of this study was to review our clinical experience with endovascular treatment of aortic arch aneurysms using different commercially available grafts (Gore, Talent, Endomed, Cook). METHODS: From 1999 to 2004, 97 patients received endovascular treatment for diseases of the thoracic aorta. In 30 cases (26 males, 4 females) the aortic arch was involved. The left subclavian artery was overstented (Ishimaru zone '2') in 18 cases (60%). Only in the first three cases had the subclavian artery been revascularized. The left common and subclavian arteries were covered (zone '1') in 6 (20%) cases-all had the carotid artery reconstructed, either simultaneously (five cases) or as a staged procedure (one case). Finally, the whole aortic arch was over-stented (zone '0') in 6 (20%) cases, with simultaneous (five cases) or staged (one case) grafting of the supra-aortic vessels from the ascending aorta. RESULTS: Perioperative mortality was 2/30 (7%), due to graft migration (zone '2') and intra-operative stroke (zone '0'), respectively. One minor stroke was observed. No cases of paraplegia were recorded. Three type I endoleaks were observed. Two resolved at 6 months follow-up; one zone '0' graft is still being followed. There was one surgical conversion for endograft failure 2 weeks after implantation. Thus, the technical success rate was 87% (26/30) cases. The mean follow-up time was 23+/-17 months. No new onset endoleaks or aneurysm-related deaths were recorded. CONCLUSIONS: Currently available grafts may be deployed in the aortic arch in most instances. De-branching of the aortic arch with surgical revascularization for zone '0' and '1' seems to be adequate to obtain a satisfactory proximal landing zone.     

一期杂交手术治疗弓部和胸腹段主动脉病变

目的 总结单中心手术结合微创的杂交技术,同期治疗弓部、胸腹段主动脉病变的经验.方法 回顾性分析2007年6月至2008年5月在澳门仁伯爵综合医院应用杂交技术,同期治疗主动脉病变5例的临床资料.其中胸降主动脉瘤累及半弓合并夹层1例,弓降主动脉瘤1例,DebarkeyⅢ型急性主动脉夹层1例,累及双侧髂总、髂内动脉的肾下腹主动脉瘤2例.弓部近端锚定区分类,ZAP 0区2例,ZAP 2区1例.弓降主动脉瘤正中开胸行升主动脉至双侧颈总人工血管搭桥+左颈总动脉至左锁骨下动脉搭桥术,同期导管室血管造影(digital seduction angiogram,DSA)下经股动脉释放Zenith覆膜支架.Debakey Ⅲ型夹层行左颈总至左锁骨下动脉搭桥后释放覆膜支架封闭破口.对于累及双侧髂内动脉的腹主动脉瘤,预先髂内、外动脉搭桥后释放腹主动脉分叉支架.结果 手术5例均获成功,术后即刻造影和随访CTA无内漏发生,随访期2～10个月.出血量约200～600 ml之间,均未输血.1例弓部杂交术后相继发生成人呼吸窘迫综合征(adult respiratory distresssyndrome,ARDS),及急性左心衰,经积极治疗后痊愈.1例术后因心肌梗塞死亡.2例弓部杂交治疗病例各颈动脉阻断时间均小于10 min,均无神经并发症或者轻微神经症状.另1例腹主动脉瘤患者杂交术后恢复正常,无并发症.结论 应用手术结合微创这一新型杂交技术治疗胸腹各段主动脉病变,有利于减少外科创伤和体外循环等所带来的血流动力学改变.     

Aortendissektion Stanford Typ A nach supraaortalem Debranching und endovaskulärem Stenting des Aortenbogens

Combined procedures involving an endovascular stenting technique and transposition of the supra-aortic arteries have been proposed for the treatment of aneurysms or chronic dissections involving the descending thoracic aorta and the aortic arch. This novel concept abandons the use of extracorporeal circulation and can be applied without a full length sternotomy. Thus the reduction in surgical trauma and peri-proce-dural morbidity and mortality have been proposed as advantages of this novel technique. Here, we report on two cases of acute aortic dissection Stanford type A that occurred during supra-aortic debranching and endovascular stenting of the aortic arch and the descending aorta. Both cases emphasize that despite preliminary encouraging results cautious patient selection is still mandatory for supraaortic debranching and implantation of a stent graft into the aortic arch in view of different therapeutic options that are available today, including the frozen elephant trunk technique. Procedure adhering risks deserve further attention and need to be re-evaluated.