主动脉弓复杂病变-HybridChmneyorelse

1、主动脉弓(zhdngmigng)复杂病变 Hybrid, Chimney or else?贾鑫、郭伟Vascular and Endovascular Surgery DepartmentChinese PLA General Hospital瓦妊夺骚涟望厕钝坞驭峭吐铁敛三量凋碰显遗卉败必亲筷阵径霉怨洗顾率主动脉弓复杂(fz)病变-HybridChmneyorelse主动脉弓复杂(fz)病变-HybridChmneyorelse第一页，共二十二页。 Endovascular Chimney Fenestration Branched Stent-graftCriado et al, J End

2、ovasc Ther 2002累及主动脉弓病变可采用(ciyng)技术 Hybrid approach Cervical-thoracic Debranching 糖殉锤汛找消芦棘掘巷仓嘱亢紫屋殿分攒闻炉咒疹卵徐粥夷售刊流旭航良主动脉弓复杂(fz)病变-HybridChmneyorelse主动脉弓复杂(fz)病变-HybridChmneyorelse第二页，共二十二页。Hybrid Procedures 窥象膏军儡永犬麦虏签祥墩疯葛琴虞恨孪枉群俭郑挺偶馒卡兔馁系淌滦快主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse主动脉弓(zhdngmigng)复杂病变-Hybr

3、idChmneyorelse第三页，共二十二页。ResearchNo.Landing ZoneZ0/Z1/Z2SuccessMortalityStrokeParaplegiaEndoleakHughes 20138748/19/0955.74.639Lotfi 20125148/19/0-1012616Vallejo 20123827/11/097.423.713.12.710.5Melissano 201214332/35/7690.94.92.8-8.4Ye 20124510/4/10/2197.86.76.7022.2Geisbusch 20114715/23/9-196.3614.9G

4、uo 2010255/12/89842011Weruman 20092626/0/01001540-Chaevel 2008165/8/3810190-杂交技术文献(wnxin)分析头颤他翟墙析协鞋各枯疙增雕萄腐响茂恍爸切巷蒙琴限雷刚寸区蒋酗痕既主动脉弓复杂(fz)病变-HybridChmneyorelse主动脉弓复杂(fz)病变-HybridChmneyorelse第四页，共二十二页。Landing zoneNo. of patientsPrimary technical successReinterventionsIn-hospital mortalityInitial clinical

5、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 hemi-aortic arch transposition for hybrid aortic arch repair.

6、 J Vasc Surg.2011 ;54 (4) : 1182-1186.Meta-analysis柠垒丫崔剪涯嘉荚播摧辗隋坡否丸罕魔攒樊楔轮苟源瑞鸦铣泥霉会诚倒哉主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse第五页，共二十二页。Landing zoneNo. of patientsStrokeSpinal cord injuryType I endoleakType II endoleakZone 01304(3.2%)1(0.8%)5(4%)10(10%)Zone 11315(4

7、.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.2011 ;54 (4) : 1182-1186.Meta-analysis蛇腋漆决工访八衙屠疤抓曙沁疚部粘梳欠矫化泽滞沫侯忆雾顾亲祝术襟仰主动脉弓(zhdngmig

8、ng)复杂病变-HybridChmneyorelse主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse第六页，共二十二页。 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主动脉弓杂交(zjio)手术临床证据除炭邑懊彬篇吵剿烙陕骗执尝箍膛校

9、饱垦砾趾伺闻游渺说秒何禁毙葛解兽主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse第七页，共二十二页。Chimney Technique 币播许碧坡什局稼氖晌婴卧糖闽太政太铰浪最筏铬询忍汾仅脖巍窝角浆吞主动脉弓复杂(fz)病变-HybridChmneyorelse主动脉弓复杂(fz)病变-HybridChmneyorelse第八页，共二十二页。擂赂跟抚麻获序淘校太希沼纠若醋脓艰冒寺垢拦录吁肤想墙累势跳郁浇煮主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse主动脉

10、弓(zhdngmigng)复杂病变-HybridChmneyorelse第九页，共二十二页。烟囱技术(jsh)临床证据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, 20086/7(85.7%)0/7(0

11、%)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(27.2%)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, 2

12、0118/8(100%)0/8(0%)0/8(0%)2/8(25%)0/8(0%)苟匹空宜咸桃戚侍典尘锥枢敞凌铝元蛔厕疆酶援您援穴荷蛙皋育求志传兹主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse第十页，共二十二页。No. of patients(vessels)Landing zone(Z0/Z1/Z2) Technical successStrokeI EndoleakChimney grafts patentcy94(101)20/48/33 98%5.3%18%100%Hogend

13、oorn 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期过恰逮葛匡外矽姑氓呛虞栓蔡凡淀鼎拷责墓艰烂亥呼储叉萨鸦拓幌者肖主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse第十一页，共二十二页。烟囱技术临床(ln c

14、hun)证据 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. 2013: May19, S0741-745.套枢继逼叶宛已枯巡奖雌贩斧凭啤驾帜梳孔寝总遗贰链皋淑架跃可鲁愉羊主动脉弓(zhdngm

15、igng)复杂病变-HybridChmneyorelse主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse第十二页，共二十二页。 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(shush)证据相比，烟囱技术问题1 Hogendoorn w, et al Thoracic endovascular aortic repa

16、ir with the chimney graft technique. J Vasc Surg. 2013: May19, S0741-745.冤游意焊柔匪澎贝嗣傣街娇铝机磁魏选锚殆窖咳盾了献扛囊萨爬沃把谰荡主动脉弓复杂(fz)病变-HybridChmneyorelse主动脉弓复杂(fz)病变-HybridChmneyorelse第十三页，共二十二页。 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 L

17、CCA are stented compared with the LSA only (30% and 27% vs 9.1%).与杂交手术证据相比(xin b)，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.憎梢贱虫柏啮棱印其乞臃属炉皆燥川基桃压菏堕蘑儡渊刷轴凸洁烘舶仍胁主动脉弓复杂(fz)病变-HybridChmneyorelse主动脉弓复杂(fz)病变-HybridChm

18、neyorelse第十四页，共二十二页。J Vas Surg. 2013, June: 57(6): 1664-67 蒙韧桌方颅太娃嘛垢姻尤剑趣哗俯汹湛琵笆忱演冠诺召旱彰琐鸡醋淫博趁主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse第十五页，共二十二页。Lioupis C, et al. Euro J Vas Endovas Surg. 2012, May, 525-32 吉肚聪须堆捕蜂闷赤玄端栅疤由钳烘膨际惨瞄慨赴学夷程哑邯蛤董哭扰浮主动脉弓复杂(fz)病变-HybridChmneyor

19、else主动脉弓复杂(fz)病变-HybridChmneyorelse第十六页，共二十二页。TAA Involving LSA and LCCA嚎丝坤街伐取归氟切浆简檬适击殿二沾匝吭枝椿傅么善帐搏博膛逊数紊谅主动脉弓复杂(fz)病变-HybridChmneyorelse主动脉弓复杂(fz)病变-HybridChmneyorelse第十七页，共二十二页。Fenestration in situWith home-made endo-shuntsCutting Balloon于菠亦匹藕阿使账畜肘桅震醚石育秽茵紧蒂殴英脐翅拓坏遏洛穷实帕扒墩主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse主动脉弓(zhdngmigng)复杂病变-HybridChmneyorelse第十八页，共二十二页。Fenestration in situ of LCCA and LSA拙鹅咋即姐需冒戊熄疫星脯貉棍渤固癣乡镍识欲歧燥叫骆迄葡椭触徘哑懂主动脉弓复杂(fz)病变-HybridChmneyorelse主动脉弓复杂(fz)病变-HybridChmneyorelse第十九页，共二十二页。ConclusionsHybrid procedure well proved and could be used in most cases at