主動脈弓復(fù)雜病變ppt課件

1、自動脈弓復(fù)雜病變自動脈弓復(fù)雜病變 Hybrid, Chimney or Hybrid, Chimney or else?else?賈鑫、郭偉賈鑫、郭偉Vascular and Endovascular Surgery Vascular and Endovascular Surgery DepartmentDepartmentChinese PLA General HospitalChinese PLA General Hospitalu Endovascularu Chimneyu Fenestrationu Branched Stent-graftCriado et al, J Endova

2、sc Ther 2002累及自動脈弓病變可采用技術(shù)u Hybrid approachu Cervical-thoracicu Debranching Hybrid Procedures ResearchNo.Landing ZoneZ0/Z1/Z2SuccessMortalityStrokeParaplegiaEndoleakHughes 20138748/19/0955.74.639Lotfi 20125148/19/0-1012616Vallejo 20123827/11/097.423.713.12.710.5Melissano 201214332/35/7690.94.92.8-8.4

3、Ye 20124510/4/10/2197.86.76.7022.2Geisbusch 20114715/23/9-196.3614.9Guo 2010255/12/89842011Weruman 20092626/0/01001540-Chaevel 2008165/8/3810190-雜交技術(shù)文獻分析Landing zoneNo. of patientsPrimary technical successReinterventionsIn-hospital mortalityInitial clinical successLate mortalityZone 0130120（95.2%）12

4、(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%）182（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.2021 ;54 (4) : 1182-1186.Met

5、a-analysisLanding zoneNo. of patientsStrokeSpinal cord injuryType I endoleakType II endoleakZone 01304(3.2%)1(0.8%)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 t

6、ransposition for hybrid aortic arch repair. J Vasc Surg.2021 ;54 (4) : 1182-1186.Meta-analysis In-hospital mortality is 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自動脈弓雜交手術(shù)臨床證據(jù)Chi

7、mney Technique 煙囪技術(shù)臨床證據(jù)煙囪技術(shù)臨床證據(jù)sourcesTechnical success Perioperative mortality(all-cause)Perioperative morbidityEndoleakStrokeLarzon et al, 20051/2(50%)0/2(0%)0/2(0%)2/2(100%)0/2(0%)Criado et al, 20078/8(100%)0/8(0%)0/8(0%)0/8(0%)0/8(0%)Baldwin et al, 20216/7(85.7%)0/7(0%)1/7(14.1%)2/7(28.5%)1/7(14

8、.2%)Ohrlander, et al, 20213/4(75%)0/4(0%)1/4(25%)2/4(50%)1/4(25%)Sugiura, et al, 20219/11(81.8%)2/11(18.1%)a3/11(27.2%)2/11(18.2%)1/11(9.1)Cires et al, 20219/9(100%)1/9(11/1%)2/9(22.2%)1/9(11.1%)1/9(11.1%)Yoshida et al,20212/2(100%)0/2(0%)0/2(0%)0/2(0%)0/2(0%) Sue et al, 20218/8(100%)0/8(0%)0/8(0%)2

9、/8(25%)0/8(0%) No. of patients(vessels)Landing zone(Z0/Z1/Z2) Technical successStrokeI EndoleakChimney grafts patentcy94(101)20/48/33 98%5.3%18%100%Hogendoorn w, et al Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2021: May19, S0741-745.Meta- analysis of clinical

10、 outcomes with chimney煙囪技術(shù)臨床證據(jù) Overall perioperative mortality (3.2%) Morbidity rate(stroke rate 5.3%) Graft patency(100%) All comparable to hybrid series.Hogendoorn w, et al Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2021: May19, S0741-745. All the chimney st

11、ents were off label use, the sample number small, most less than 10 cases. Relative new, with a median follow-up of 11 months與雜交手術(shù)證據(jù)相比，煙囪技術(shù)問題1 Hogendoorn w, et al Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2021: May19, S0741-745. In chimney seris, nearly 1/3 i

12、n 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%).與雜交手術(shù)證據(jù)相比，煙囪技術(shù)問題 Hogendoorn w, et al Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2021: May19, S0741-745.J

13、 Vas Surg. 2021, June: 57(6): 1664-67 Lioupis C, et al. Euro J Vas Endovas Surg. 2021, May, 525-32 TAA Involving LSA and LCCA Fenestration in situWith home-made endo-shuntsCutting BalloonFenestration in situ of LCCA and LSAConclusionsl Hybrid procedure well proved and could be used in most cases at present tim