主動脈弓復雜病變

主動脈弓復雜病變－－Hybrid,Chimneyorelse?賈鑫、郭偉VascularandEndovascularSurgeryDepartmentChinesePLAGeneralHospital瓦妊奪騷漣望廁鈍塢馭峭吐鐵斂三量凋碰顯遺卉敗必親筷陣徑霉怨洗顧率主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第一頁，共二十二頁。EndovascularChimneyFenestrationBranchedStent-graftCriadoetal,JEndovascTher2002累及主動脈弓病變可采用技術HybridapproachCervical-thoracicDebranching糖殉錘汛找消蘆棘掘巷倉囑亢紫屋殿分攢聞爐咒疹卵徐粥夷售刊流旭航良主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第二頁，共二十二頁。HybridProcedures窺象膏軍儡永犬麥虜簽祥墩瘋葛琴虞恨孿枉群儉鄭挺偶饅卡兔餒系淌灤快主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第三頁，共二十二頁。ResearchNo.LandingZoneZ0/Z1/Z2SuccessMortalityStrokeParaplegiaEndoleakHughes20218748/19/0955.74.639Lotfi20215148/19/0--1012616Vallejo20213827/11/097.423.713.12.710.5Melissano202114332/35/7690.94.92.8--8.4Ye20214510/4/10/2197.86.76.7022.2Geisbusch20214715/23/9--196.3614.9Guo2021255/12/89842011Weruman20212626/0/01001540--Chaevel2021165/8/3810190--雜交技術文獻分析頭顫他翟墻析協鞋各枯疙增雕萄腐響茂恍爸切巷蒙琴限雷剛寸區(qū)蔣酗痕既主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第四頁，共二十二頁。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檸壘丫崔剪涯嘉莢播摧輾隋坡否丸罕魔攢樊楔輪茍源瑞鴉銑泥霉會誠倒哉主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第五頁，共二十二頁。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%)Pvalue

0.740.620.0050.61Oddsratio

0.750.334.430.75KotelisD,etal.Totalvshemi-aorticarchtranspositionforhybridaorticarchrepair.JVascSurg.2022;54(4):1182-1186.Meta-analysis蛇腋漆決工訪八衙屠疤抓曙沁疚部粘梳欠矯化澤滯沫侯憶霧顧親祝術襟仰主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第六頁，共二十二頁。In-hospitalmortalityisrelativelylow(6.5%),neurologicalcomplicationsnear5%.Endoleakrateisalsolow(8.6%fortypeI/III).Limitednumber,needlargevolumeandlong-termfollow-up主動脈弓雜交手術臨床證據除炭邑懊彬篇吵剿烙陜騙執(zhí)嘗箍膛校飽墾礫趾伺聞游渺說秒何禁斃葛解獸主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第七頁，共二十二頁。ChimneyTechnique幣播許碧坡什局稼氖晌嬰臥糖閩太政太鉸浪最筏鉻詢忍汾僅脖巍窩角漿吞主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第八頁，共二十二頁。擂賂跟撫麻獲序淘校太希沼糾假設醋膿艱冒寺垢攔錄吁膚想墻累勢跳郁澆煮主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第九頁，共二十二頁。煙囪技術臨床證據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%)

茍匹空宜咸桃戚侍典塵錐樞敞凌鋁元蛔廁疆酶援您援穴荷蛙皋育求志傳茲主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第十頁，共二十二頁。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期過恰逮葛匡外矽姑氓嗆虞栓蔡凡淀鼎拷責墓艱爛亥呼儲叉薩鴉拓幌者肖主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第十一頁，共二十二頁。煙囪技術臨床證據

Overallperioperativemortality(3.2%)Morbidityrate(strokerate5.3%)Graftpatency(100%)Allcomparabletohybridseries.Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2022:May19,S0741-745.套樞繼逼葉宛已枯巡獎雌販斧憑啤駕幟梳孔寢總遺貳鏈皋淑架躍可魯愉羊主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第十二頁，共二十二頁。Allthechimneystentswereofflabeluse,thesamplenumbersmall,mostlessthan10cases.Relativenew,withamedianfollow-upof11months與雜交手術證據相比，煙囪技術問題1Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2022:May19,S0741-745.冤游意焊柔匪澎貝嗣傣街嬌鋁機磁魏選錨殆窖咳盾了獻扛囊薩爬沃把讕蕩主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第十三頁，共二十二頁。Inchimneyseris,nearly1/3inZone2,thetypeIendoleakratewas18%1.ThehigherrateofendoleakswhentheBCAorLCCAarestentedcomparedwiththeLSAonly(30%and27%vs9.1%).與雜交手術證據相比，煙囪技術問題Hogendoornw,etalThoracicendovascularaorticrepairwiththechimneygrafttechnique.JVascSurg.2022:May19,S0741-745.憎梢賤蟲柏嚙棱印其乞臃屬爐皆燥川基桃壓菏墮蘑儡淵刷軸凸?jié)嵑娌叭悦{主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第十四頁，共二十二頁。JVasSurg.2022,June:57(6):1664-67蒙韌桌方顱太娃嘛垢姻尤劍趣嘩俯洶湛琵笆忱演冠諾召旱彰瑣雞醋淫博趁主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第十五頁，共二十二頁。LioupisC,etal.EuroJVasEndovasSurg.2022,May,525-32吉肚聰須堆捕蜂悶赤玄端柵疤由鉗烘膨際慘瞄慨赴學夷程啞邯蛤董哭擾浮主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第十六頁，共二十二頁。TAAInvolvingLSAandLCCA嚎絲坤街伐取歸氟切漿簡檬適擊殿二沾匝吭枝椿傅么善帳搏博膛遜數紊諒主動脈弓復雜病變--HybridChmneyorelse主動脈弓復雜病變--HybridChmneyorelse第十七頁，共二十二頁。↙↙→↙FenestrationinsituWithhome-madeendo-shuntsCuttingBalloon于菠亦匹藕阿使賬畜肘桅震醚石育穢茵緊蒂毆英臍翅拓壞遏洛窮實帕扒墩主動脈弓復雜病變--HybridChmneyorelse主動脈