1、主动脉弓复杂病变主动脉弓复杂病变 Hybrid,Chimney or else?贾鑫、郭伟贾鑫、郭伟 Vascular and Endovascular Surgery Department Chinese PLA General Hospital 瓦妊夺骚涟望厕钝坞驭峭吐铁敛三量凋碰显遗卉败必亲筷阵径霉怨洗顾率主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse Endovascular Chimney Fenestration Branched Stent-graft Criado et al,J Endovasc Ther 2002
2、 累及主动脉弓病变可采用技术 Hybrid approach Cervical-thoracic Debranching 糖殉锤汛找消芦棘掘巷仓嘱亢紫屋殿分攒闻炉咒疹卵徐粥夷售刊流旭航良主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse Hybrid Procedures 窥象膏军儡永犬麦虏签祥墩疯葛琴虞恨孪枉群俭郑挺偶馒卡兔馁系淌滦快主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse Research No.Landing Zone Z0/Z1/Z2 Success Morta
3、lity Stroke Paraplegia Endoleak Hughes 2013 87 48/19/0 95 5.7 4.6 3 9 Lotfi 2012 51 48/19/0-10 12 6 16 Vallejo 2012 38 27/11/0 97.4 23.7 13.1 2.7 10.5 Melissano 2012 143 32/35/76 90.9 4.9 2.8-8.4 Ye 2012 45 10/4/10/21 97.8 6.7 6.7 0 22.2 Geisbusch 2011 47 15/23/9-19 6.3 6 14.9 Guo 2010 25 5/12/8 98
4、4 2 0 11 Weruman 2009 26 26/0/0 100 15 4 0-Chaevel 2008 16 5/8/3 81 0 19 0-杂交技术文献分析 头颤他翟墙析协鞋各枯疙增雕萄腐响茂恍爸切巷蒙琴限雷刚寸区蒋酗痕既主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse Landing zone No.of patients Primary technical success Reinterventions In-hospital mortality Initial clinical success Late mortali
5、ty Zone 0 130 120（95.2%）12(12%)11（8.5%）111（88.1%）0 Zone 1 131 70（83.3%）16(25.8%)6（4.6%）71（84.5%）2 Total 261 190（90.5%）28（17.3%）17（6.5%）182（86.7%）2 P value 0.0069 0.0321 0.22 0.53 0.16 Odds ratio 4 2.55 1.93 1.35 N/A Kotelis D,et al.Total vs hemi-aortic arch transposition for hybrid aortic arch repai
6、r.J Vasc Surg.2011;54(4):1182-1186.Meta-analysis 柠垒丫崔剪涯嘉荚播摧辗隋坡否丸罕魔攒樊楔轮苟源瑞鸦铣泥霉会诚倒哉主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse Landing zone No.of patients Stroke Spinal cord injury Type I endoleak Type II endoleak Zone 0 130 4(3.2%)1(0.8%)5(4%)10(10%)Zone 1 131 5(4.2%)3(2.3%)13(15.5%)8(12.9
7、%)Total 261 9(3.7%)4(1.5%)18(8.6%)18(11.1%)P value 0.74 0.62 0.005 0.61 Odds ratio 0.75 0.33 4.43 0.75 Kotelis D,et al.Total vs hemi-aortic arch transposition for hybrid aortic arch repair.J Vasc Surg.2011;54(4):1182-1186.Meta-analysis 蛇腋漆决工访八衙屠疤抓曙沁疚部粘梳欠矫化泽滞沫侯忆雾顾亲祝术襟仰主动脉弓复杂病变-HybridChmneyorelse主动脉弓复
8、杂病变-HybridChmneyorelse In-hospital mortality is relatively low(6.5%),neurological complications near 5%.Endoleak rate is also low(8.6%for type I/III).Limited number,need large volume and long-term follow-up 主动脉弓杂交手术临床证据 除炭邑懊彬篇吵剿烙陕骗执尝箍膛校饱垦砾趾伺闻游渺说秒何禁毙葛解兽主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmney
9、orelse Chimney Technique 币播许碧坡什局稼氖晌婴卧糖闽太政太铰浪最筏铬询忍汾仅脖巍窝角浆吞主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse 擂赂跟抚麻获序淘校太希沼纠若醋脓艰冒寺垢拦录吁肤想墙累势跳郁浇煮主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse 烟囱技术临床证据烟囱技术临床证据 sources Technical success Perioperative mortality(all-cause)Perioperative morbidity
10、Endoleak Stroke Larzon et al,2005 1/2(50%)0/2(0%)0/2(0%)2/2(100%)0/2(0%)Criado et al,2007 8/8(100%)0/8(0%)0/8(0%)0/8(0%)0/8(0%)Baldwin et al,2008 6/7(85.7%)0/7(0%)1/7(14.1%)2/7(28.5%)1/7(14.2%)Ohrlander,et al,2008 3/4(75%)0/4(0%)1/4(25%)2/4(50%)1/4(25%)Sugiura,et al,2009 9/11(81.8%)2/11(18.1%)a 3/11
11、(27.2%)2/11(18.2%)1/11(9.1)Cires et al,2011 9/9(100%)1/9(11/1%)2/9(22.2%)1/9(11.1%)1/9(11.1%)Yoshida et al,2011 2/2(100%)0/2(0%)0/2(0%)0/2(0%)0/2(0%)Sue et al,2011 8/8(100%)0/8(0%)0/8(0%)2/8(25%)0/8(0%)苟匹空宜咸桃戚侍典尘锥枢敞凌铝元蛔厕疆酶援您援穴荷蛙皋育求志传兹主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse No.of patie
12、nts(vessels)Landing zone(Z0/Z1/Z2)Technical success Stroke I Endoleak Chimney grafts patentcy 94(101)20/48/33 98%5.3%18%100%Hogendoorn w,et al Thoracic endovascular aortic repair with the chimney graft technique.J Vasc Surg.2013:May19,S0741-745.Meta-analysis of clinical outcomes with chimney 期过恰逮葛匡外
13、矽姑氓呛虞栓蔡凡淀鼎拷责墓艰烂亥呼储叉萨鸦拓幌者肖主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse 烟囱技术临床证据 Overall perioperative mortality(3.2%)Morbidity rate(stroke rate 5.3%)Graft patency(100%)All comparable to hybrid series.Hogendoorn w,et al Thoracic endovascular aortic repair with the chimney graft technique.J V
14、asc Surg.2013:May19,S0741-745.套枢继逼叶宛已枯巡奖雌贩斧凭啤驾帜梳孔寝总遗贰链皋淑架跃可鲁愉羊主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse All the chimney stents were off label use,the sample number small,most less than 10 cases.Relative new,with a median follow-up of 11 months 与杂交手术证据相比，烟囱技术问题 1 Hogendoorn w,et al Thora
15、cic endovascular aortic repair with the chimney graft technique.J Vasc Surg.2013:May19,S0741-745.冤游意焊柔匪澎贝嗣傣街娇铝机磁魏选锚殆窖咳盾了献扛囊萨爬沃把谰荡主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse In chimney seris,nearly 1/3 in Zone 2,the type I endoleak rate was 18%1.The higher rate of endoleaks when the BCA or
16、 LCCA are stented compared with the LSA only(30%and 27%vs 9.1%).与杂交手术证据相比，烟囱技术问题 Hogendoorn w,et al Thoracic endovascular aortic repair with the chimney graft technique.J Vasc Surg.2013:May19,S0741-745.憎梢贱虫柏啮棱印其乞臃属炉皆燥川基桃压菏堕蘑儡渊刷轴凸洁烘舶仍胁主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse J Vas Surg.2013,June:57(6):1664-67 蒙韧桌方颅太娃嘛垢姻尤剑趣哗俯汹湛琵笆忱演冠诺召旱彰琐鸡醋淫博趁主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse Lioupis C,et al.Euro J Vas Endovas Surg.2012,May,525-32 吉肚聪须堆捕蜂闷赤玄端栅疤由钳烘膨际惨瞄慨赴学夷程哑邯蛤董哭扰浮主