篇名 | Endovascular Aortic Arch Reconstruction with Parallel Grafts: A Dilemma of Excessive Endograft Oversizing |
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卷期 | 36:4 |
作者 | Huey-Shiuan Kuo 、 Kun-Cheng Tsai 、 Jer-Shen Chen |
頁次 | 351-359 |
關鍵字 | Aortic aneurysm 、 Aortic dissection 、 Chimney 、 Periscope 、 Thoracic endovascular aortic repair 、 MEDLINE 、 Scopus 、 SCIE |
出刊日期 | 202007 |
DOI | 10.6515/ACS.202007_36(4).20200109A |
Background: Preservation of supra-aortic branches in thoracic endovascular aortic repair plays a role in associated neurological outcomes, and the strategy varies. Objectives: This study aimed to evaluate the safety and efficacy of a parallel graft technique to reconstruct the aortic arch. Methods: From August 2014 to July 2018, a total of 25 patients with thoracic aortic pathologies requiring arch reconstruction were included. All patients underwent thoracic aortic endovascular repair (TEVAR) with a zone 1 landing aortic stent graft, a chimney graft to preserve the left common carotid artery, and a periscope graft to preserve the left subclavian artery. The associated outcomes and complications were reported. Results: Eighteen patients presented with aortic dissection, 4 with a thoracic aortic aneurysm, 1 with a penetrating aortic ulcer, 1 with a traumatic aortic injury, and 1 case of re-TEVAR. The technical success rate was 96% (24/25), but the case of immediate failure died of retrograde type A dissection. Over a mean follow-up of 32.33 months, another retrograde type A aortic dissection was detected in 1month, and a case of early failure (< 1 year) and 3 cases of late failure (> 1 year) whose primary aortic problems recurred were detected. Conclusions: This study demonstrates a total endovascular approach to preserve supra-aortic branches with a parallel graft technique. However, the dilemma of excessive graft oversizing was disclosed due to the risk of retrograde type A dissections and an unsatisfactory durability in this small series.