Morrissey N J, Yano O J, Soundararajan K, Eisen L, McArthur C, Teodorescu V, Kerstein M, Hollier L, Marin M L
Department of Surgery, Division of Vascular Surgery, The Mount Sinai School of Medicine, New York, NY 10029, USA.
J Vasc Surg. 2001 Sep;34(3):503-12. doi: 10.1067/mva.2001.114811.
Standard surgical repair of para-anastamotic aneurysms (PAAs) of the abdominal and thoracic aorta and the iliac arteries has been associated with high morbidity and mortality rates. We reviewed our continuing experience with endovascular repair of these lesions to determine whether this approach is favorable and durable.
All patients with PAAs of the aorta or iliac arteries who underwent endovascular treatment of their lesions between August 1993 and July 1999 were prospectively followed up, and data on age, previous aortic pathology and surgery, size of PAA, time to diagnosis, and symptoms at presentation were recorded. Preoperative, intraoperative, and postoperative imaging studies were analyzed. All patients had endovascular stent-grafts placed under digital fluoroscopic guidance in the operating room. Data on intraoperative and postoperative complications, mortality, and endoleaks were reviewed.
From August 1993 to July 1999, 28 patients (20 men, 8 women) had 35 PAAs of the aorta or iliac arteries. There were 5 thoracic aortic, 12 abdominal aortic, and 18 iliac artery PAAs. Three patients had a contained rupture of their PAA. All patients who had originally undergone reconstruction for occlusive disease had lesions consistent with false aneurysms, whereas 73% of the aortic or iliac PAAs in patients originally treated for aneurysm disease appeared to be true aneurysms. Thirty-four of 35 PAAs were successfully excluded with stent-grafts (97%). There was one death at 30 days (3.6%) in a patient who was successfully treated endovascularly for a contained rupture of a thoracic PAA. There were four major postoperative complications (14.2%) in the 28 patients who were treated. One patient had continued perfusion of a thoracic aortic PAA (type I endoleak). The in-hospital length of stay after endovascular repair of PAA was 4 days (range, 1-18 days). The mean follow-up period was 21 months (range, 1-68 months).
Endovascular repair of aortic and iliac artery PAAs is technically feasible and provides a high rate of lesion exclusion. Morbidity and mortality rates appear lower than those reported for open surgical repair. These patients can typically be discharged by the second postoperative day. Endovascular therapy for stable ruptured PAAs can be successfully performed and should be considered as an option only when appropriate devices and expertise are available. For uncomplicated PAAs of the aorta and iliac arteries, endovascular therapy may be more favorable than surgical repair.
腹主动脉、胸主动脉及髂动脉吻合口旁动脉瘤（PAA）的标准外科修复与高发病率和死亡率相关。我们回顾了我们在这些病变的血管腔内修复方面的持续经验，以确定这种方法是否有利且持久。
对1993年8月至1999年7月间接受血管腔内治疗其病变的所有主动脉或髂动脉PAA患者进行前瞻性随访，并记录年龄、既往主动脉病变及手术史、PAA大小、诊断时间及就诊时症状。分析术前、术中和术后影像学研究。所有患者均在手术室数字荧光透视引导下放置血管腔内支架移植物。回顾术中及术后并发症、死亡率及内漏的数据。
1993年8月至1999年7月，28例患者（20例男性，8例女性）有35个主动脉或髂动脉PAA。其中胸主动脉PAA 5个，腹主动脉PAA 12个，髂动脉PAA 18个。3例患者的PAA有局限性破裂。所有最初因闭塞性疾病接受重建的患者病变均符合假性动脉瘤，而最初因动脉瘤疾病接受治疗的患者中，73%的主动脉或髂动脉PAA似乎是真性动脉瘤。35个PAA中有34个通过支架移植物成功排除（97%）。1例因胸主动脉PAA局限性破裂接受血管腔内成功治疗的患者在30天时死亡（3.6%）。28例接受治疗的患者中有4例发生主要术后并发症（14.2%）。1例患者的胸主动脉PAA持续灌注（I型内漏）。PAA血管腔内修复后的住院时间为4天（范围1 - 18天）。平均随访期为21个月（范围1 - 68个月）。
主动脉和髂动脉PAA的血管腔内修复在技术上是可行的，且病变排除率高。发病率和死亡率似乎低于开放手术修复报道的水平。这些患者通常可在术后第二天出院。对于稳定的破裂性PAA，血管腔内治疗可以成功进行，且仅在有合适的设备和专业技术时才应考虑作为一种选择。对于主动脉和髂动脉的非复杂性PAA，血管腔内治疗可能比手术修复更有利。
