Hybrid Procedures in Treatment for Aortic Arch Lesions: Short- and Long-Term Results_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Hongpeng , GUO Wei , LIU Xiaoping , YIN Tai , JIA Xin , XIONG Jiang , MA Xiaohui , ZHANG Minhong , XU Yongle.

Department of Vascular Surgery, General Hospital of People’s Liberation Army, Beijing 100853, China;

Corresponding author：

Keywords：

Thoracic aortic aneurysms; Aortic dissection; Aortic arch; Hybrid procedures; Endovascular repair

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ObjectiveTo evaluate the short-and long-term results of hybrid procedures in the treatment for aortic arch lesions. MethodsFrom October 2002 to March 2011, 28 patients with thoracic aortic aneurysms or dissections involving the aortic arch were treated with hybrid endovascular treatment in our center. Twenty-two males and 6 females were in the series. The mean age of the patients was 68 years old. Of 28 patients, 15 were atherosclerotic thoracic aortic aneurysms and 13 were thoracic aortic dissection. Follow-up protocol consisted of computed tomography (CT) angiograms or ultrasound was performed in 3, 6, and 12 months, and annually thereafter. The main goal was to evaluate the operative mortality, morbidity, and the longterm survival of these patients. ResultsHybrid procedures included 12 totalarch transpositions, 3 left common carotid artery (LCCA)left subclavian artery (LSA) bypass, 11 right common carotid artery (RCCA)LCCA-LSA bypass, 2 RCCA-LCCA bypass. The technical success rate was 92.9% (26/28). The complications occurred in 10 patients (35.7%). Operative mortality was 7.1% (2/28). The apoplexia rate was 7.1% (2/28). The time of followup was (36±3) months. The patency rates of 1-year, 3-year, and 5-year were 100%, 92.9% (26/28), and 85.7% (24/28), respectively. The survival rates of 1-year, 3-year, and 5-year were 89.3% (25/28), 71.4% (20/28), and 60.7% (17/28), respectively. ConclusionsThe short-and long-term results with hybrid procedures in the treatment for aortic arch diseases are satisfactory. Further reducing the complications is the key to increase the survival rate.

Citation： ZHANG Hongpeng,GUO Wei,LIU Xiaoping,YIN Tai,JIA Xin,XIONG Jiang,MA Xiaohui,ZHANG Minhong,XU Yongle.. Hybrid Procedures in Treatment for Aortic Arch Lesions: Short- and Long-Term Results. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(10): 1039-1042. doi: Copy

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12.	Olsson C, Thelin S, Sthle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide populationbased study of more than 14 000 cases from 1987 to 2002 [J]. Circulation, 2006, 114(24): 26112618.
13.	Greenberg RK, Haddad F, Svensson L, et al. Hybrid approaches to thoracic aortic aneurysms: the role of endovascular elephant trunk completion [J]. Circulation, 2005, 112(17): 26192626.
14.	Noor N, Sadat U, Hayes PD, et al. Management of the left subclavian artery during endovascular repair of the thoracic aorta [J]. J Endovasc Ther, 2008, 15(2): 168176.
15.	郭伟，张宏鹏，刘小平，等． “烟囱”技术在主动脉弓病变腔内修复术中的应用 [J]．中华普通外科杂志， 2010， 25（7）： 536539．.
16.	Schumacher H, Von TenggKobligk H, Ostovic M, et al. Hybrid aortic procedures for endoluminal arch replacement in thoracic aneurysms and type B dissections [J]. J Cardiovasc Surg (Torino), 2006, 47(5): 509517.
17.	Wang S, Chang G, Li X, et al. Endovascular treatment of arch and proximal thoracic aortic lesions [J]. J Vasc Surg, 2008, 48(1): 6468.
18.	Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones [J]. Eur J Vasc Endovasc Surg, 2007, 33(5): 561566.
19.	McWilliams RG, Murphy M, Hartley D, et al. In situ stentgraft fenestration to preserve the left subclavian artery [J]. J Endovasc Ther, 2004, 11(2): 170174.
20.	Wei G, Xin J, Yang D, et al. A new modular stent graft to reconstruct aortic arch [J]. Eur J Vasc Endovasc Surg, 2009, 37(5): 560565.

1. Matalanis G, Hata M, Buxton BF. A retrospective comparative study of deep hypothermic circulatory arrest, retrograde, and antegrade cerebral perfusion in aortic arch surgery [J]. Ann Thorac Cardiovasc Surg, 2003, 9(3): 174179.
2. Nakai M, Shimamoto M, Yamazaki F, et al. Longterm results after surgery for aortic arch nondissection aneurysm [J]. Kyobu Geka, 2002, 55(4): 280284.
3. Niinami H, Aomi S, Chikazawa G, et al. Progress in the treatment of aneurysms of the distal aortic arch: approach through median sternotomy [J]. J Cardiovasc Surg (Torino), 2003, 44(2): 243248.
4. Guo W, Liu X, Liang F, et al. Transcarotid artery endovascular reconstruction of the aortic arch by modified bifurcated stent graft for Stanford type A dissection [J]. Asian J Surg, 2007, 30(4): 290295.
5. Inoue K, Hosokawa H, Iwase T, et al. Aortic arch Reconstruction by transluminally placed endovascular branched stent graft [J]. Circulation, 1999, 100(19 Suppl): Ⅱ316Ⅱ321.
6. Schoder M, Lammer J, Czerny M. Endovascular aortic arch repair: hopes and certainties [J]. Eur J Vasc Endovasc Surg, 2009, 38(3): 255261.
7. Brinkman WT, Szeto WY, Bavaria JE. Stent graft treatment for transverse arch and descending thoracic aorta aneurysms [J]. Curr Opin Cardiol, 2007, 22(6): 510516.
8. Moon MC, Morales JP, Greenberg RK. The aortic arch and ascending aorta: are they within the endovascular realm? [J]. Semin Vasc Surg, 2007, 20(2): 97107.
9. Nashef SA, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE) [J]. Eur J Cardiothorac Surg, 1999, 16(1): 913.
10. Mitchell RS, Ishimaru S, Ehrlich MP, et al. First international summit on thoracic aortic endografting: roundtable on thoracic aortic dissection as an indication for endografting [J]. J Endovasc Ther, 2002, 9 Suppl 2: Ⅱ98Ⅱ105.
11. 张宏鹏，郭伟，刘小平，等．完全穿刺技术在腹主动脉瘤腔内修复术中的应用 [J]．中华外科杂志， 2010， 48（24）： 18551858．.
12. Olsson C, Thelin S, Sthle E, et al. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide populationbased study of more than 14 000 cases from 1987 to 2002 [J]. Circulation, 2006, 114(24): 26112618.
13. Greenberg RK, Haddad F, Svensson L, et al. Hybrid approaches to thoracic aortic aneurysms: the role of endovascular elephant trunk completion [J]. Circulation, 2005, 112(17): 26192626.
14. Noor N, Sadat U, Hayes PD, et al. Management of the left subclavian artery during endovascular repair of the thoracic aorta [J]. J Endovasc Ther, 2008, 15(2): 168176.
15. 郭伟，张宏鹏，刘小平，等． “烟囱”技术在主动脉弓病变腔内修复术中的应用 [J]．中华普通外科杂志， 2010， 25（7）： 536539．.
16. Schumacher H, Von TenggKobligk H, Ostovic M, et al. Hybrid aortic procedures for endoluminal arch replacement in thoracic aneurysms and type B dissections [J]. J Cardiovasc Surg (Torino), 2006, 47(5): 509517.
17. Wang S, Chang G, Li X, et al. Endovascular treatment of arch and proximal thoracic aortic lesions [J]. J Vasc Surg, 2008, 48(1): 6468.
18. Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones [J]. Eur J Vasc Endovasc Surg, 2007, 33(5): 561566.
19. McWilliams RG, Murphy M, Hartley D, et al. In situ stentgraft fenestration to preserve the left subclavian artery [J]. J Endovasc Ther, 2004, 11(2): 170174.
20. Wei G, Xin J, Yang D, et al. A new modular stent graft to reconstruct aortic arch [J]. Eur J Vasc Endovasc Surg, 2009, 37(5): 560565.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Hybrid Procedures in Treatment for Aortic Arch Lesions: Short- and Long-Term Results

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