[精品]主动脉弓复杂病变--HybridChmneyorelseVIP免费

主动脉弓复杂病变－－Hybrid,Chimneyorelse?贾鑫、郭伟VascularandEndovascularSurgeryDepartmentChinesePLAGeneralHospitalEndovascularChimneyFenestrationBranchedStent-graftCriadoetal,JEndovascTher2002累及主动脉弓病变可采用技术HybridapproachCervical-thoracicDebranchingHybridProceduresResearchNo.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.2011;54(4):1182-1186.Meta-analysisLandingzoneNo.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.2011;54(4):1182-1186.Meta-analysis•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ChimneyTechnique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,20086/7(85.7%)0/7(0%)1/7(14.1%)2/7(28.5%)1/7(14.2%)Ohrlander,etal,20083/4(75%)0/4(0%)1/4(25%)2/4(50%)1/4(25%)Sugiura,etal,20099/11(81.8%)2/11(18.1%)a3/11(27.2%)2/11(18.2%)1/11(9.1)Ciresetal,20119/9(100%)1/9(11/1%)2/9(22.2%)1/9(11.1%)1/9(11.1%)Yoshidaetal,20112/2(100%)0/2(0%)0/2(0%)0/2(0%)0/2(0%)Sueetal,20118/8(100%)0/8(0%)0/8(0%)2/8(25%)0/8(0%)No.ofpatients(vessels)Landingzone(Z0/Z1/Z2)TechnicalsuccessStrokeIEndoleakChimneygraftspatentcy94(101)20/48/3398%5.3%18%100%Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.Meta-analysisofclinicaloutcomeswithchimney烟囱技术临床证据•Overallperioperativemortality(3.2%)•Morbidityrate(strokerate5.3%)•Graftpatency(100%)Allcomparabletohybridseries.Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.•Allthechimneystentswereofflabeluse,thesamplenumbersmall,mostlessthan10cases.•Relativenew,withamedianfollow-upof11months与杂交手术证据相比，烟囱技术问题1Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2013:May19,S0741-745.•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.2013:May19,S0741-745.JVasSurg.2013,June:57(6):1664-67LioupisC,etal.EuroJVasEndovasSurg.2012,May,525-32TAAInvolvingLSAandLCCA↙↙→↙FenestrationinsituWithhome-madeendo-shuntsCuttingBalloonFenestrationinsituofLCCAandLSAConclusionsHybridprocedurewellprovedandcouldbeusedinmostcasesatpresenttime.Chimneygraftsshouldonlybeusedinspecificcases(eg.highsurgicalrisk,Zone2).Fenestrationandbranchedgraftsneedfurtherinvestigation.Thanksforyourattention