Fenestrated/Branched Physician-Modified Endovascular Grafts for Aortic Pathologies Involving the Aberrant Subclavian Artery.

IF 1.7 2区 医学 Q3 PERIPHERAL VASCULAR DISEASE
Lu Yu, Xiaolang Jiang, Guanyu Qiao, Min Zhou, Weiguo Fu, Zhihui Dong
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Abstract

Purpose: The case series aim to explore the feasibility and effectiveness of using fenestrated/branched physician-modified endovascular grafts (PMEGs) to treat aortic pathologies involving the aberrant subclavian artery (ASA).

Technique: We presented 3 cases with multiple anomalies and complications related to the ASA. Two patients had aberrant right subclavian arteries (ARSA) and developed aortic dissection spontaneously or iatrogenically after endovascular intervention for myocardial infarction. The third patient had an aberrant left subclavian artery (ALSA) together with a Kommerell's diverticulum (KD) arising from a right-sided aortic arch and developed an aortic dissection. In all 3 cases, an Ankura thoracic endograft (Lifetech, Shenzhen, China) was back-table modified by adding an inner branch and a fenestration for bilateral subclavian arteries, respectively. All procedures were successfully conducted, and all patients underwent 6-month follow-up courses, which were uneventful.

Conclusion: Our case series demonstrate a feasible and less invasive therapeutic approach, which produces promising results in treating the aortic pathologies involving the ASA. Further studies and long-term follow-up are required to refine this technical approach and to validate its durability.

Clinical impact: The case series illustrate a total endovascular approach to treat aortic arch pathologies involving the ASA, which is one of the most frequent aortic arch anomalies. The use of PMEGs allows meticulous subclavian artery reconstruction without significant trauma brought by traditional open or hybrid approach. Our cases suggest that using PMEGs for total endovascular management of patients with ASA is feasible and effective, and it may help streamline the treatment of complex aortic pathologies.

开窗/分支医师改良血管内移植物治疗锁骨下动脉病变。
目的:本研究旨在探讨开窗/分支医师改良血管内移植物(PMEGs)治疗锁骨下动脉(ASA)病变的可行性和有效性。技术:我们报告了3例与ASA相关的多发性异常和并发症。2例右锁骨下动脉(ARSA)异常,在心肌梗死血管内介入治疗后自发或医源性发生主动脉夹层。第三例患者左侧锁骨下动脉(ALSA)异常,并伴有右侧主动脉弓引起的Kommerell憩室(KD),并发主动脉夹层。在所有3例病例中,Ankura胸腔内移植物(Lifetech, Shenzhen, China)分别通过增加双侧锁骨下动脉的内分支和开窗进行了背部改良。所有手术均顺利进行,所有患者均进行了为期6个月的随访。结论:我们的病例系列证明了一种可行且侵入性较小的治疗方法,在治疗涉及ASA的主动脉病变方面取得了令人鼓舞的结果。需要进一步的研究和长期的后续行动来完善这一技术方法并验证其耐久性。临床影响:该病例系列说明了全血管内入路治疗主动脉弓病变,包括ASA,这是最常见的主动脉弓异常之一。pmeg的使用允许细致的锁骨下动脉重建,而不会像传统的开放或混合入路那样带来明显的创伤。我们的病例表明,使用pmeg对ASA患者进行全血管内管理是可行和有效的,它可能有助于简化复杂主动脉病变的治疗。
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
CiteScore
5.30
自引率
15.40%
发文量
203
审稿时长
6-12 weeks
期刊介绍: The Journal of Endovascular Therapy (formerly the Journal of Endovascular Surgery) was established in 1994 as a forum for all physicians, scientists, and allied healthcare professionals who are engaged or interested in peripheral endovascular techniques and technology. An official publication of the International Society of Endovascular Specialists (ISEVS), the Journal of Endovascular Therapy publishes peer-reviewed articles of interest to clinicians and researchers in the field of peripheral endovascular interventions.
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