Krohg-Sørensen Kirsten, Hafsahl Geir, Fosse Erik, Geiran Odd R
Department of Thoracic and Cardiovascular Surgery, Rikshositalet University Hospital, N-0027 Oslo, Norway.
Eur J Cardiothorac Surg. 2003 Sep;24(3):379-87. doi: 10.1016/s1010-7940(03)00330-0.
To report our experience with endovascular stentgraft repair of diseases of the descending thoracic aorta in high risk patients.
Twenty-one procedures were performed in 20 patients (10 women), aged 22-81 years, for disease of the descending thoracic aorta with the Gore Excluder thoracic endoprosthesis (WL Gore) (n=11) and the Talent LPS Stent Graft System (Medtronic AVE) (n=10). All patients were considered high operative risk. Diagnoses included saccular aneurysm, aneurysm rupture, mycotic aneurysm, penetrating atherosclerotic ulcer, aortic dissection and aortitis. The access vessels were a tube graft of the (thoraco-) abdominal aorta (n=4), the common iliac (n=6) and the common femoral artery (n=11). Several patients needed major cardiovascular surgery for concomitant disease during the same stay. Computed tomography scan and chest X-ray was performed at 3 and 6 months and thereafter every sixth month postoperatively.
Two patients died. One had a colon perforation 8 days postoperatively and died after 3.5 months, and the other with preoperative sepsis and a mycotic aneurysm died on day 11 from cardiac and renal failure. In one patient the stentgraft dislocated during release, and an additional stentgraft had to be implanted 1 week later to treat the proximal leak. In another patient the stentgraft could not be released from the introducer, and was pulled back to the aortic bifurcation and retrieved through laparotomy. Eighteen patients have been followed for 1-24 months, and no migration, wire fractures or endoleak have been seen. There were no neurologic complications. One patient treated for infected pseudoaneurysm had a chronic graft infection.
In this small number of patients with high operative risk, short-term results of endovascular stentgraft repair of variable diseases of the descending aorta have been satisfactory. Stentgraft repair could be a valuable supplement to surgery for patients with complex multilevel or multiorgan disease.
报告我们在高危患者中使用血管内支架移植物修复胸降主动脉疾病的经验。
对20例患者（10例女性）进行了21例手术，患者年龄22 - 81岁，均因胸降主动脉疾病使用戈尔胸主动脉覆膜支架（WL Gore）（n = 11）和泰伦特LPS支架移植物系统（美敦力AVE）（n = 10）进行治疗。所有患者均被认为手术风险高。诊断包括囊状动脉瘤、动脉瘤破裂、霉菌性动脉瘤、穿透性动脉粥样硬化溃疡、主动脉夹层和主动脉炎。入路血管为（胸 -）腹主动脉人工血管（n = 4）、髂总动脉（n = 6）和股总动脉（n = 11）。部分患者在同一住院期间因合并疾病需要进行重大心血管手术。术后3个月和6个月进行计算机断层扫描和胸部X线检查，此后每6个月进行一次。
2例患者死亡。1例术后8天发生结肠穿孔，3.5个月后死亡；另1例术前有败血症和霉菌性动脉瘤，于第11天死于心肾衰竭。1例患者在释放支架移植物时发生移位，1周后不得不植入额外的支架移植物以治疗近端渗漏。另1例患者的支架移植物无法从导入器中释放，被拉回至主动脉分叉处，并通过剖腹手术取出。18例患者随访1 - 24个月，未见移位、导丝断裂或内漏。无神经并发症。1例感染性假性动脉瘤患者发生慢性移植物感染。
在这一小部分手术风险高的患者中，血管内支架移植物修复胸降主动脉多种疾病的短期结果令人满意。对于患有复杂多节段或多器官疾病的患者，支架移植物修复可能是手术的一种有价值的补充。
