定制的支架移植物对血管内皮的修复：一种对与主动脉弓有关的慢性主动脉夹层具有前景的治疗

Objective There is no approved special endovascular device for use in preventing entry tears in the distal part of ascending aorta or in the aortic arch and preserving the arch branch arteries. Thus, we have designed a novel branched stent-graft, and herein report the initial clinical outcomes. Methods Between August 2009 and January 2014, 51 patients with aortic dissections involving the aortic arch were treated by endovascular branched stent-grafts. There were 7 Stanford type A aortic dissections, 22 retrograde type A aortic dissections, and 22 Stanford type B aortic dissections (including 4 localized aortic arch dissections). All patients were treated while in the chronic phase (>2 weeks). Results All of the proximal entry tears in the arch were successfully excluded, and all of the treated branch arteries remained patent. No new cerebral infarction occurred. There was 1 death from a retrograde type A dissection, occurring 6 days after the endovascular procedure. The median follow-up period was 44 months (range, 14-66 months). No additional complications or mortality occurred. Complete thrombosis in the false lumen of the aortic arch was formed in all patients, and significant true lumen recovery and false lumen shrinkage were demonstrated in different levels of the thoracic aorta according to computed tomography angiography at 1 year postsurgery (P <.001). Conclusions In patients with aortic dissection involving the arch branches, the customized branched stent-graft may provide a feasible endovascular treatment option. A larger series of cases with longer follow-up is needed to substantiate these results. © 2015 The American Association for Thoracic Surgery.