[精品]主动脉弓复杂病变--HybridChmneyorelse.pptx

主动脉弓复杂病变 Hybrid,Chimney or else?,贾鑫、郭伟Vascular and Endovascular Surgery DepartmentChinese 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,第一页，共二十二页。,Endovascular Chimney Fenestration Branched Stent-graft,Criado et al,J Endovasc Ther 2002,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,第二页，共二十二页。,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,第三页，共二十二页。,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,第四页，共二十二页。,Kotelis D,et al.Total vs hemi-aortic arch transposition for hybrid aortic arch repair.J Vasc Surg.2022;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,第五页，共二十二页。,Kotelis D,et al.Total vs hemi-aortic arch transposition for hybrid aortic arch repair.J Vasc Surg.2022;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主动脉弓复杂病变-HybridChmneyorelse,第六页，共二十二页。,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-HybridChmneyorelse,第七页，共二十二页。,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,第八页，共二十二页。,擂赂跟抚麻获序淘校太希沼纠假设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,第九页，共二十二页。,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%),0/8(0%),0/8(0%),0/8(0%),Baldwin et al,2022,6/7(85.7%),0/7(0%),1/7(14.1%),2/7(28.5%),1/7(14.2%),Ohrlander,et al,2022,3/4(75%),0/4(0%),1/4(25%),2/4(50%),1/4(25%),Sugiura,et al,2022,9/11(81.8%),2/11(18.1%)a,3/11(27.2%),2/11(18.2%),1/11(9.1),Cires et al,2022,9/9(100%),1/9(11/1%),2/9(22.2%),1/9(11.1%),1/9(11.1%),Yoshida et al,2022,2/2(100%),0/2(0%),0/2(0%),0/2(0%),0/2(0%),Sue et al,2022,8/8(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,第十页，共二十二页。,Hogendoorn w,et al Thoracic endovascular aortic repair with the chimney graft technique.J Vasc Surg.2022:May19,S0741-745.,Meta-analysis of clinical outcomes with chimney,期过恰逮葛匡外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,第十一页，共二十二页。,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 Vasc Surg.2022: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,第十二页，共二十二页。,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 Thoracic endovascular aortic repair with the chimney graft technique.J Vasc Surg.2022: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,第十三页，共二十二页。,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 graft technique.J Vasc Surg.2022: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,第十四页，共二十二页。,J Vas Surg.2022,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,第十五页，共二十二页。,Lioupis C,et al.Euro J Vas Endovas Surg.2022,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动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse,第十六页，共二十二页。,TAA Involving LSA and LCCA,嚎丝坤街伐取归氟切浆简檬适击殿二沾匝吭枝椿傅么善帐搏博膛逊数紊谅主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse,第十七页，共二十二页。,Fenestration in situWith home-made endo-shunts,Cutting Balloon,于菠亦匹藕阿使账畜肘桅震醚石育秽茵紧蒂殴英脐翅拓坏遏洛穷实帕扒墩主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse,第十八页，共二十二页。,Fenestration in situ of LCCA and LSA,拙鹅咋即姐需冒戊熄疫星脯貉棍渤固癣乡镍识欲歧燥叫骆迄葡椭触徘哑懂主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse,第十九页，共二十二页。,Conclusions,Hybrid procedure well proved and could be used in most cases at present time.Chimney grafts should only be used in specific cases(eg.high surgical risk,Zone 2).Fenestration and branched grafts need further investigation.,旅酝劲获儡务彝干峰驴删月憾赏糠佬星挥震凳零镊汪誊鞋躬诊漠抡府眷卤主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse,第二十页，共二十二页。,Thanks for your attention,购笔粪睦牵吟淆扰蘑屎凹泣赢趁绳草沽颂押廉假设啮重咎疹陕冻而抬钮黔速主动脉弓复杂病变-HybridChmneyorelse主动脉弓复杂病变-HybridChmneyorelse,第二十一页，共二十二页。,内容总结,主动脉弓复杂病变 Hybrid,Ch