{"title":"在开放式修复术后,用双瓣 PMEG 排除升主动脉吻合口动脉瘤。","authors":"","doi":"10.1016/j.avsg.2024.07.093","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The objective of this case series is to investigate the outcomes of double-fenestrated physician-modified endografts (PMEGs) in patients with distal anastomotic aneurysms after open repair of the ascending aorta or proximal arch replacement.</p></div><div><h3>Methods</h3><p>All consecutive patients with a distal anastomotic aneurysm after open ascending aorta surgery who underwent aortic arch repair with a homemade double-fenestrated stent-graft from 2017 to 2023 were reviewed. Study endpoints included technical success, 30-day, and long-term follow up analysis of mortality, morbidity, and reinterventions.</p></div><div><h3>Results</h3><p>10 patients were treated with double-fenestrated PMEGs for anastomotic aneurysms after open surgery of the ascending aorta. Of these, 9 were male with a mean age of 58 years. Nine patients were initially treated for acute dissection, and 2 had mechanical aortic valves. The mean time between open surgery and the treatment of the pseudoaneurysm was 4.15 years. Technical success was 100%. The proximal landing zone was consistently in zone 0, and all endografts were deployed via femoral access. Early outcomes revealed one endoleak (type 1a), which was successfully treated by prompt reintervention. No deaths or strokes occurred during the early postoperative period. During long-term follow up (mean time 35 months), no endoleaks requiring intervention occurred, and there were no reports of stent fractures or migrations. No patient died from an aortic-related cause.</p></div><div><h3>Conclusions</h3><p>Aortic arch repair with double-fenestrated PMEGs for distal anastomotic aneurysms after open surgery is feasible and represents a promising alternative in patients ineligible for redo surgery.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Ascending Aorta Anastomotic Aneurysm Exclusion with Double-Fenestrated PMEG after Open Repair\",\"authors\":\"\",\"doi\":\"10.1016/j.avsg.2024.07.093\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The objective of this case series is to investigate the outcomes of double-fenestrated physician-modified endografts (PMEGs) in patients with distal anastomotic aneurysms after open repair of the ascending aorta or proximal arch replacement.</p></div><div><h3>Methods</h3><p>All consecutive patients with a distal anastomotic aneurysm after open ascending aorta surgery who underwent aortic arch repair with a homemade double-fenestrated stent-graft from 2017 to 2023 were reviewed. Study endpoints included technical success, 30-day, and long-term follow up analysis of mortality, morbidity, and reinterventions.</p></div><div><h3>Results</h3><p>10 patients were treated with double-fenestrated PMEGs for anastomotic aneurysms after open surgery of the ascending aorta. Of these, 9 were male with a mean age of 58 years. Nine patients were initially treated for acute dissection, and 2 had mechanical aortic valves. The mean time between open surgery and the treatment of the pseudoaneurysm was 4.15 years. Technical success was 100%. The proximal landing zone was consistently in zone 0, and all endografts were deployed via femoral access. Early outcomes revealed one endoleak (type 1a), which was successfully treated by prompt reintervention. No deaths or strokes occurred during the early postoperative period. During long-term follow up (mean time 35 months), no endoleaks requiring intervention occurred, and there were no reports of stent fractures or migrations. No patient died from an aortic-related cause.</p></div><div><h3>Conclusions</h3><p>Aortic arch repair with double-fenestrated PMEGs for distal anastomotic aneurysms after open surgery is feasible and represents a promising alternative in patients ineligible for redo surgery.</p></div>\",\"PeriodicalId\":8061,\"journal\":{\"name\":\"Annals of vascular surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-08-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of vascular surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0890509624004904\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0890509624004904","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
Ascending Aorta Anastomotic Aneurysm Exclusion with Double-Fenestrated PMEG after Open Repair
Background
The objective of this case series is to investigate the outcomes of double-fenestrated physician-modified endografts (PMEGs) in patients with distal anastomotic aneurysms after open repair of the ascending aorta or proximal arch replacement.
Methods
All consecutive patients with a distal anastomotic aneurysm after open ascending aorta surgery who underwent aortic arch repair with a homemade double-fenestrated stent-graft from 2017 to 2023 were reviewed. Study endpoints included technical success, 30-day, and long-term follow up analysis of mortality, morbidity, and reinterventions.
Results
10 patients were treated with double-fenestrated PMEGs for anastomotic aneurysms after open surgery of the ascending aorta. Of these, 9 were male with a mean age of 58 years. Nine patients were initially treated for acute dissection, and 2 had mechanical aortic valves. The mean time between open surgery and the treatment of the pseudoaneurysm was 4.15 years. Technical success was 100%. The proximal landing zone was consistently in zone 0, and all endografts were deployed via femoral access. Early outcomes revealed one endoleak (type 1a), which was successfully treated by prompt reintervention. No deaths or strokes occurred during the early postoperative period. During long-term follow up (mean time 35 months), no endoleaks requiring intervention occurred, and there were no reports of stent fractures or migrations. No patient died from an aortic-related cause.
Conclusions
Aortic arch repair with double-fenestrated PMEGs for distal anastomotic aneurysms after open surgery is feasible and represents a promising alternative in patients ineligible for redo surgery.
期刊介绍:
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence