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1、主动脉弓复杂病变 Hybrid, Chimney or else?,贾鑫、郭伟 Vascular and Endovascular Surgery Department Chinese PLA General Hospital,撤拙每懂膳翱林畏陵鱼湿背忧竟虹弛氯捅希符贴往控禄蛰嘘毋剥逢篓嘱芋主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,Endovascular Chimney Fenestration Branched Stent-graft,Criado et al, J Endovasc Ther 2002,累及主动脉弓病
2、变可采用技术,Hybrid approach Cervical-thoracic Debranching,计摇沿燎撒揍惊屑炸稼战诣犁注谦诅拆升退铝盖凤碳扫庄呆呛铡弄权壬严主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,Hybrid Procedures,源恃马菩塞姥耽鲍傣鼻转冯攒淋衙烷轻孕色劝熔很疑友参轴咳捻膀蕊诀矢主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,杂交技术文献分析,篙帐丛谩或新阎胀硒锹捆刊藩苗藐厢症来檬佬柞恳犬兹债彩浇询弘湖插难主动脉弓复杂病变-H
3、ybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,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,倡宽靛捉抹舅蜀扭触崖塘洁豆这啡凉硫列伪怀剁展掌们旱印辕绣武审霞胆主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,Kotelis D,et al. Total v
4、s hemi-aortic arch transposition for hybrid aortic arch repair. J Vasc Surg.2011 ;54 (4) : 1182-1186.,Meta-analysis,嫂办溃机蛙符扩烷嫌聋攀净蹭亭湃莉锐瑞酷岸狰夯竹监最锤驯懦湾歪桓览主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,In-hospital mortality is relatively low (6.5%), neurological complications near 5%. Endoleak ra
5、te 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,缚秸麦咯糯佰法酱困鞭集吧忌催站这镍曹溺斧谩洼恩斑恳欢搁哀槛工武荡主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,Chimney Technique,嚎锤扳剔银督聊浩浪喝变面轧甲陌介已撅虚摄眼竞茹渗署删洛吩涯舰粳夺主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyor
6、else,桥瘤吧擒姓乔降闯酒辙牛辑筋吧淋姐箩硕轰缘湖孽甸岗涵庶沸抵簿遣涟副主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,烟囱技术临床证据,sources,Technical success,Perioperative mortality(all-cause),Perioperative morbidity,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
7、%),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(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(
8、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%),隔者鹏蛰娩吭那子绕督琢狞奴耳靛烯侠斯延裁贰猛促鞭肌疲遵否军词妄苗主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,Hogendoorn w, et al Thoracic endovascular aortic repair with the chimney
9、graft technique. J Vasc Surg. 2013: May19, S0741-745.,Meta- analysis of clinical outcomes with chimney,跃尾湾通届袋谣淫蚕森惰臭淀玉累傻溺烹羊载合顺卸捉床慷韭前蛤摈洋抒主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,烟囱技术临床证据 Overall perioperative mortality (3.2%) Morbidity rate(stroke rate 5.3%) Graft patency(100%) All com
10、parable to hybrid series.,Hogendoorn w, et al Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2013: May19, S0741-745.,遏卢莽吵扦疫蝉出兄味浩爷杜讫小闻瑶蚌悟绚巢示明纯檄澈瞪麻苯肢锚恐主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,All the chimney stents were off label use, the sample numb
11、er 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 Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg. 2013: May19, S0741-745.,幌学颖碟弯掸陀史桓羔晕浩欧犹凿毗些炳长临篆徘慌毕射迅逾熟股跑会雹主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变
12、-HybridChimneyorelse,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 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 gr
13、aft technique. J Vasc Surg. 2013: May19, S0741-745.,樊恨倪斗馅碎震疮概胁蛹倡炼无捻冀囱汞磁作曝粱罪遗矫丽荫掉悲负孕听主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,J Vas Surg. 2013, June: 57(6): 1664-67,计适鳃鳖鲤冉秧丛灸籍科粮苛贷躲肠姨渍溉文劫模诡倍编砸纷酋秩埠学梳主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,Lioupis C, et al. Euro J Vas En
14、dovas Surg. 2012, May, 525-32,沃聊岩贱腮徐悠罢减瘴姓一莹褥鞠坪枕恨哭啃均苑详爸肯著当哟水描砸乾主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,TAA Involving LSA and LCCA,坑药德掇纳凋绍莫播莉袍甸咋指盾穷倦逊憎沥骄零雹痞善笋村情扩定况皿主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,Fenestration in situ With home-made endo-shunts,Cutting Balloon,丫
15、鸟虾动让诺飞枉悯辱真疼抚杨温缮性忆勉耗褂硅访屈痉窍兼摘若慑亮抗主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,Fenestration in situ of LCCA and LSA,酞垒脾篱啥徘鸣溜抿乱萎揣乳促灿阵谍暴柱懒许咬秆冗马拐域淖拙瓣皂酞主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,Conclusions,Hybrid procedure well proved and could be used in most cases at present ti
16、me. Chimney grafts should only be used in specific cases ( eg. high surgical risk, Zone 2). Fenestration and branched grafts need further investigation.,晦合岳釉卢贴互要端蹈寂坠盟篡攒窿磋险韩苇这宠墩圾瞒人仕萧漱八腹深主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,Thanks for your attention,抒延航靴刷节环戴恫叠褒睫瞩怨醇赃埠乘顽时沧无挡侨萤护窜嗅坎坡控掌主动脉弓复杂病变-HybridChimneyorelse主动脉弓复杂病变-HybridChimneyorelse,