主动脉弓复杂病变

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1、主动脉弓复杂病变－－Hybrid,Chimneyorelse?贾鑫、郭伟VascularandEndovascularSurgeryDepartmentChinesePLAGeneralHospitalEndovascularChimneyFenestrationBranchedStent-graftCriadoetal,JEndovascTher2002累及主动脉弓病变可采用技术HybridapproachCervical-thoracicDebranchingHybridProceduresResearchNo.LandingZo

2、neZ0/Z1/Z2SuccessMortalityStrokeParaplegiaEndoleakHughes20138748/19/0955.74.639Lotfi20125148/19/0--1012616Vallejo20123827/11/097.423.713.12.710.5Melissano201214332/35/7690.94.92.8--8.4Ye20124510/4/10/2197.86.76.7022.2Geisbusch20114715/23/9--196.3614.9Guo2010255/12/89842

3、011Weruman20092626/0/01001540--Chaevel2008165/8/3810190--杂交技术文献分析LandingzoneNo.ofpatientsPrimarytechnicalsuccessReinterventionsIn-hospitalmortalityInitialclinicalsuccessLatemortalityZone0130120（95.2%）12(12%)11（8.5%）111（88.1%）0Zone113170（83.3%）16(25.8%)6（4.6%）71（84.5%）2T

4、otal261190（90.5%）28（17.3%）17（6.5%）182（86.7%）2Pvalue0.00690.03210.220.530.16Oddsratio42.551.931.35N/AKotelisD,etal.Totalvshemi-aorticarchtranspositionforhybridaorticarchrepair.JVascSurg.2011;54(4):1182-1186.Meta-analysisLandingzoneNo.ofpatientsStrokeSpinalcordinjuryTypeI

5、endoleakTypeIIendoleakZone01304(3.2%)1(0.8%)5(4%)10(10%)Zone11315(4.2%)3(2.3%)13(15.5%)8(12.9%)Total2619(3.7%)4(1.5%)18(8.6%)18(11.1%)Pvalue0.740.620.0050.61Oddsratio0.750.334.430.75KotelisD,etal.Totalvshemi-aorticarchtranspositionforhybridaorticarchrepair.JVascSurg.201

6、1;54(4):1182-1186.Meta-analysisIn-hospitalmortalityisrelativelylow(6.5%),neurologicalcomplicationsnear5%.Endoleakrateisalsolow(8.6%fortypeI/III).Limitednumber,needlargevolumeandlong-termfollow-up主动脉弓杂交手术临床证据ChimneyTechnique烟囱技术临床证据sourcesTechnicalsuccessPerioperativemor

7、tality(all-cause)PerioperativemorbidityEndoleakStrokeLarzonetal,20051/2(50%)0/2(0%)0/2(0%)2/2(100%)0/2(0%)Criadoetal,20078/8(100%)0/8(0%)0/8(0%)0/8(0%)0/8(0%)Baldwinetal,20086/7(85.7%)0/7(0%)1/7(14.1%)2/7(28.5%)1/7(14.2%)Ohrlander,etal,20083/4(75%)0/4(0%)1/4(25%)2/4(50%

8、)1/4(25%)Sugiura,etal,20099/11(81.8%)2/11(18.1%)a3/11(27.2%)2/11(18.2%)1/11(9.1)Ciresetal,20119/9(100%)1/9(11/