主动脉弓复杂病变--HybridChmneyorelse 医学教学课件VIP免费

主动脉弓复杂病变－－Hybrid,Chimneyorelse?第一页，共二十二页。EndovascularChimneyFenestrationBranchedStent-graftCriadoetal,JEndovascTher2002累及主动脉弓病变可采用技术HybridapproachCervical-thoracicDebranching第二页，共二十二页。HybridProcedures第三页，共二十二页。ResearchNo.LandingZoneZ0/Z1/Z2SuccessMortalityStrokeParaplegiaEndoleakHughes20138748/19/0955.74.639Lotfi20125148/19/0--1012616Vallejo20123827/11/097.423.713.12.710.5Melissano201214332/35/7690.94.92.8--8.4Ye20124510/4/10/2197.86.76.7022.2Geisbusch20114715/23/9--196.3614.9Guo2010255/12/89842011Weruman20092626/0/01001540--Chaevel2008165/8/3810190--杂交技术文献分析第四页，共二十二页。LandingzoneNo.ofpatientsPrimarytechnicalsuccessReinterventionsIn-hospitalmortalityInitialclinicalsuccessLatemortalityZone0130120（95.2%）12(12%)11（8.5%）111（88.1%）0Zone113170（83.3%）16(25.8%)6（4.6%）71（84.5%）2Total261190（90.5%）28（17.3%）17（6.5%）182（86.7%）2Pvalue0.00690.03210.220.530.16Oddsratio42.551.931.35N/AKotelisD,etal.Totalvshemi-aorticarchtranspositionforhybridaorticarchrepair.JVascSurg.2022;54(4):1182-1186.Meta-analysis第五页，共二十二页。LandingzoneNo.ofpatientsStrokeSpinalcordinjuryTypeIendoleakTypeIIendoleakZone01304(3.2%)1(0.8%)5(4%)10(10%)Zone11315(4.2%)3(2.3%)13(15.5%)8(12.9%)Total2619(3.7%)4(1.5%)18(8.6%)18(11.1%)Pvalue0.740.620.0050.61Oddsratio0.750.334.430.75KotelisD,etal.Totalvshemi-aorticarchtranspositionforhybridaorticarchrepair.JVascSurg.2022;54(4):1182-1186.Meta-analysis第六页，共二十二页。•In-hospitalmortalityisrelativelylow(6.5%),neurologicalcomplicationsnear5%.•Endoleakrateisalsolow(8.6%fortypeI/III).•Limitednumber,needlargevolumeandlong-termfollow-up主动脉弓杂交手术临床证据第七页，共二十二页。ChimneyTechnique第八页，共二十二页。第九页，共二十二页。烟囱技术临床证据sourcesTechnicalsuccessPerioperativemortality(all-cause)PerioperativemorbidityEndoleakStrokeLarzonetal,20051/2(50%)0/2(0%)0/2(0%)2/2(100%)0/2(0%)Criadoetal,20078/8(100%)0/8(0%)0/8(0%)0/8(0%)0/8(0%)Baldwinetal,20226/7(85.7%)0/7(0%)1/7(14.1%)2/7(28.5%)1/7(14.2%)Ohrlander,etal,20223/4(75%)0/4(0%)1/4(25%)2/4(50%)1/4(25%)Sugiura,etal,20229/11(81.8%)2/11(18.1%)a3/11(27.2%)2/11(18.2%)1/11(9.1)Ciresetal,20229/9(100%)1/9(11/1%)2/9(22.2%)1/9(11.1%)1/9(11.1%)Yoshidaetal,20222/2(100%)0/2(0%)0/2(0%)0/2(0%)0/2(0%)Sueetal,20228/8(100%)0/8(0%)0/8(0%)2/8(25%)0/8(0%)第十页，共二十二页。No.ofpatients(vessels)Landingzone(Z0/Z1/Z2)TechnicalsuccessStrokeIEndoleakChimneygraftspatentcy94(101)20/48/3398%5.3%18%100%Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2022:May19,S0741-745.Meta-analysisofclinicaloutcomeswithchimney第十一页，共二十二页。烟囱技术临床证据•Overallperioperativemortality(3.2%)•Morbidityrate(strokerate5.3%)•Graftpatency(100%)Allcomparabletohybridseries.Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2022:May19,S0741-745.第十二页，共二十二页。•Allthechimneystentswereofflabeluse,thesamplenumbersmall,mostlessthan10cases.•Relativenew,withamedianfollow-upof11months与杂交手术证据相比，烟囱技术问题1Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2022:May19,S0741-745.第十三页，共二十二页。•Inchimneyseris,nearly1/3inZone2,thetypeIendoleakratewas18%1.•ThehigherrateofendoleakswhentheBCAorLCCAarestentedcomparedwiththeLSAonly(30%and27%vs9.1%).与杂交手术证据相比，烟囱技术问题Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2022:May19,S0741-745.第十四页，共二十二页。JVasSurg.2022,June:57(6):1664-67第十五页，共二十二页。LioupisC,etal.EuroJVasEndovasSurg.2022,May,525-32第十六页，共二十二页。TAAInvolvingLSAandLCCA第十七页，共二十二页。↙↙→↙FenestrationinsituWithhome-madeendo-shuntsCuttingBalloon第十八页，共二十二页。FenestrationinsituofLCCAandLSA第十九页，共二十二页。ConclusionsHybridprocedurewellprovedandcouldbeusedinmostcasesatpresenttime.Chimneygraftsshouldonlybeusedinspecificcases(eg.highsurgicalrisk,Zone2).Fenestrationandbranchedgraftsneedfurtherinvestigation.第二十页，共二十二页。Thanksforyourattention第二十一页，共二十二页。内容总结主动脉弓复杂病变－－Hybrid,Chimneyorelse。2/2(100%)。2/2(100%)。8/8(100%)。9/9(100%)。Yoshidaetal,2022。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复杂病变--HybridChmneyorelse主动脉弓复杂病变--HybridChmneyorelse。Conclusions第二十二页，共二十二页。