Endovascular Repair of Penetrating Thoracic Aortic Ulcers Using Tubular Stent Grafts Versus Stent Grafts With a Proximal Scallop.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-10-01 Epub Date: 2023-01-20 DOI:10.1177/15266028221149919

Alexander Kupferthaler, Sven R Hauck, Michael Schwarz, Maximilian Kern, Julia Deinsberger, Theresa-Marie Dachs, Christoph Neumayer, Maria-Elisabeth Stelzmüller, Marek Ehrlich, Christian Loewe, Martin A Funovics

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引用次数: 0

Abstract

Purpose: In penetrating aortic ulcers (PAUs), limited data support tubular thoracic endovascular aortic repair (TEVAR) as a viable treatment option. For treatment of more proximal PAUs, hybrid approaches and-more recently-scalloped TEVAR (scTEVAR) have been advocated. Outcomes of scTEVAR specifically for PAUs have not yet been reported. This study reports long-term outcomes for tubular and scTEVAR in PAUs and compares the safety profile in both cohorts regarding the significantly more proximal landing zone (LZ) for scTEVAR.

Materials and methods: This single-center retrospective cohort study includes all nonacute patients treated for complicated PAU with scTEVAR and tubular TEVAR. Patient and PAU characteristics as well as procedural success, complication and reintervention rates, and all-cause and aortic mortality were analyzed.

Results: Of 212 TEVAR procedures reviewed, 21 patients with tubular TEVAR and 19 patients with scTEVAR were included. Patient and PAU characteristics were similar, and LZ was significantly more proximal in the scTEVAR cohort (p=0.0001), with similar number and types of supra-aortic revascularization procedures. Clinical success was reached in all 40 patients (100%), and reintervention rate was 2/21 (9.5%) and 1/19 (5.3%), respectively. Over the mean follow-up of 63 (TEVAR) and 53 (scTEVAR) months, clinical success was stable in all patients with one (abdominal) aortic-related mortality in the scTEVAR cohort.

Conclusion: Treatment of complicated PAUs with TEVAR as well as scTEVAR provides excellent and similar clinical success, stability of clinical success, and aortic survival with acceptable complication and reintervention rates. Scalloped TEVAR safely lengthens the proximal sealing zone to address more proximal pathologies.

Clinical impact: Treatment of asymptomatic complicated penetrating aortic ulcers (PAUs) with thoracic endovascular aortic repair (TEVAR) provides excellent clinical success and acceptable complication and reintervention rates. More patients become amenable to endovascular treatment by including scalloped TEVAR (scTEVAR) as a means to safely lengthen the proximal sealing zone to address more proximal pathologies.

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使用管状支架移植物与带近端扇贝的支架移植物对穿透性胸主动脉溃疡进行血管内修复。

目的：对于穿透性主动脉溃疡（PAU），支持管状胸腔内主动脉血管修复术（TEVAR）作为可行治疗方案的数据有限。为了治疗更近端的 PAU，人们主张采用混合方法和最近的扇形 TEVAR（scTEVAR）。专门针对 PAU 的 scTEVAR 的疗效尚未见报道。本研究报告了 PAU 管式和 scTEVAR 的长期疗效，并就 scTEVAR 明显更近的着床区（LZ）对两组患者的安全性进行了比较：这项单中心回顾性队列研究包括所有使用 scTEVAR 和管式 TEVAR 治疗复杂 PAU 的非急性期患者。研究分析了患者和 PAU 的特征以及手术成功率、并发症和再介入率、全因死亡率和主动脉死亡率：结果：在212例TEVAR手术中，21例患者接受了管式TEVAR，19例患者接受了scTEVAR。患者和PAU特征相似，scTEVAR队列中LZ明显更近（p=0.0001），主动脉上血管再通术的数量和类型相似。所有40名患者均获得临床成功（100%），再介入率分别为2/21（9.5%）和1/19（5.3%）。在平均63个月（TEVAR）和53个月（scTEVAR）的随访中，所有患者的临床成功率均保持稳定，其中scTEVAR队列中有1例（腹部）主动脉相关死亡：结论：使用 TEVAR 和 scTEVAR 治疗复杂的 PAU，可获得极佳且相似的临床成功率、临床成功率的稳定性和主动脉存活率，并发症和再介入率均可接受。扇形 TEVAR 安全地延长了近端密封区，以处理更近端的病变：临床影响：用胸腔内血管主动脉修复术（TEVAR）治疗无症状的复杂性穿透性主动脉溃疡（PAUs）可取得良好的临床成功，并发症和再介入率可接受。将扇形 TEVAR（scTEVAR）作为安全延长近端密封区的一种手段，可解决更多近端病变，从而使更多患者适合接受血管内治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.