主动脉弓复杂病变HybridChimneyorelse

1、主动脉弓复杂病变HybridChimneyorelseu Endovascular Chimney Fenestration Branched Stent-graftCriado et al, J Endovasc Ther 2002累及主动脉弓病变可采用技术u Hybrid approach Cervical-thoracic Debranching Hybrid Procedures ResearchNo.Landing ZoneZ0/Z1/Z2SuccessMortalityStrokeParaplegiaEndoleakHughes 20138748/19/0955.74.639Lot

2、fi 20125148/19/0-1012616Vallejo 20123827/11/097.423.713.12.710.5Melissano 201214332/35/7690.94.92.8-8.4Ye 20124510/4/10/2197.86.76.7022.2Geisbusch 20114715/23/9-196.3614.9Guo 2010255/12/89842011Weruman 20092626/0/01001540-Chaevel 2008165/8/3810190-杂交技术文献分析Landing zoneNo. of patientsPrimary technical

3、 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%）182（86.7%）2P value0.00690.03210.220.530.16Odds ratio42.551.931.35N/AKotelis D,et al. Total vs

4、 hemi-aortic arch transposition for hybrid aortic arch repair. J Vasc Surg.2011 ;54 (4) : 1182-1186.Meta-analysis主动脉弓复杂病变HybridChimneyorelseLanding 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%)Tot

5、al2619(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.2011 ;54 (4) : 1182-1186.Meta-analysis主动脉弓复杂病变HybridChimneyorelse In-hospital mortality is relatively low (6.5%),

6、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主动脉弓复杂病变HybridChimneyorelseChimney Technique 烟囱技术临床证据烟囱技术临床证据sourcesTechnical success Perioperative mortality(all-cause)Perioperative morbidityEnd

7、oleakStrokeLarzon 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, 20086/7(85.7%)0/7(0%)1/7(14.1%)2/7(28.5%)1/7(14.2%)Ohrlander, et al, 20083/4(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.

8、2%)2/11(18.2%)1/11(9.1)Cires et al, 20119/9(100%)1/9(11/1%)2/9(22.2%)1/9(11.1%)1/9(11.1%)Yoshida et al,20112/2(100%)0/2(0%)0/2(0%)0/2(0%)0/2(0%) Sue et al, 20118/8(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 patent

9、cy94(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. 2013: 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

10、(100%) All comparable to hybrid series.Hogendoorn w, et al Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2013: 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、11 months与杂交手术证据相比，烟囱技术问题1 Hogendoorn w, et al Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2013: 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

12、with the LSA only (30% and 27% vs 9.1%).与杂交手术证据相比，烟囱技术问题 Hogendoorn w, et al Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2013: May19, S0741-745.J Vas Surg. 2013, June: 57(6): 1664-67 Lioupis C, et al. Euro J Vas Endovas Surg. 2012, May, 525-32 TAA Involving LSA and LCCA Fenestration in situWith home-made endo-shuntsCutting BalloonConclusionsl Hybrid procedure well proved and co