Kieffer Edouard, Chiche Laurent, Baron Jean-Franois, Godet Gilles, Koskas Fabien, Bahnini Amine
Service de Chirurgie Vasculaire, Department d'Anesthésie-Réanimation Chirurgicale, CHU Pitié-Salpêtriére, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
Ann Vasc Surg. 2002 Nov;16(6):679-84. doi: 10.1007/s10016-001-0315-1. Epub 2002 Oct 31.
From January 1, 1995 to July 31, 2000, a total of 133 patients underwent elective surgical treatment for degenerative aneurysm of the descending thoracic (n = 45) or thoracoabdominal (n = 88) aorta. There were 116 men (87%) and 17 women (13%) with a mean age of 66.4 +/- 8.7 years (range, 39 to 84 years). Sixteen patients (12%) died in the immediate postoperative period. Thirteen patients (10%) had already undergone myocardial revascularizaton. Thirty-five patients (26%) presented clinical symptoms of coronary artery disease. Preoperative coronary arteriography was performed in 84 (63%) patients, demonstrating normal findings or clinically insignificant lesions in 48 patients (57%), single-vessel lesions (>70% reduction in diameter) in 19 patients, two-vessel lesions in 12 patients, and three-vessel lesions in 5 patients. On the basis of these findings, myocardial revascularization was performed before aortic repair in 11 patients. The total number of myocardial revascularization procedures in this series was 24 (18%). Four patients had previously undergone a total of 6 carotid endarterectomy procedures. Routine duplex ultrasound demonstrated significant carotid artery lesions in 12 patients (9%). Ten of these patients (8%) underwent carotid endarterectomy. The total number of carotid endarterectomy procedures in this series was 16 in 14 patients. The prevalence of coronary and carotid lesions in patients indicated for elective treatment for degenerative aneurysm of the descending thoracic or thoracoabdominal aorta was similar to that observed in patients presenting degenerative aneurysm of the infrarenal abdominal aorta. Univariate analysis demonstrated that coronary and carotid lesions with or without treatment are a significant risk factor for mortality following surgical repair of degenerative aneurysm of the descending thoracic or thoracoabdominal aorta. This finding suggests that routine preoperative coronary arteriography and duplex ultrasound are warranted.
1995年1月1日至2000年7月31日，共有133例患者因降胸段（n = 45）或胸腹段（n = 88）主动脉退行性动脉瘤接受了择期手术治疗。其中男性116例（87%），女性17例（13%），平均年龄66.4±8.7岁（范围39至84岁）。16例患者（12%）在术后即刻死亡。13例患者（10%）已接受过心肌血运重建术。35例患者（26%）有冠心病临床症状。84例（63%）患者术前行冠状动脉造影，其中48例（57%）结果正常或病变对临床无显著意义，19例为单支血管病变（直径缩小>70%），12例为双支血管病变，5例为三支血管病变。基于这些结果，11例患者在主动脉修复术前进行了心肌血运重建术。本系列中心肌血运重建术的总数为24例（18%）。4例患者此前共接受过6次颈动脉内膜切除术。常规双功超声显示12例患者（9%）有明显的颈动脉病变。其中10例患者（8%）接受了颈动脉内膜切除术。本系列中14例患者共进行了16次颈动脉内膜切除术。降胸段或胸腹段主动脉退行性动脉瘤择期治疗患者中冠状动脉和颈动脉病变的患病率与肾下腹主动脉退行性动脉瘤患者中观察到的患病率相似。单因素分析表明，无论是否接受治疗，冠状动脉和颈动脉病变都是降胸段或胸腹段主动脉退行性动脉瘤手术修复后死亡的重要危险因素。这一发现提示术前行冠状动脉造影和双功超声检查是必要的。
