Lepore V, Lönn L, Delle M, Mellander S, Rådberg G, Risberg B
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, University of Göteborg, SE 413-45 Göteborg, Sweden.
J Card Surg. 2003 Sep-Oct;18(5):436-43. doi: 10.1046/j.1540-8191.2003.02079.x.
Endovascular stent-graft treatment for true aneurysms of the descending thoracic aorta is a valid and effective alternative to conventional surgery. A review of our experience with 21 consecutive patients is reported and technical considerations are discussed.
Twenty-one patients (mean age 73 years) with true aneurysms of the descending thoracic aorta (n = 14) or contained rupture (n = 7) were treated between October 1999 and July 2001. Seven patients (33%) underwent emergency endovascular procedure. Postoperatively, the patients were followed with CT scans at 1, 3, 6, and 12 months. Follow-up, which averaged 17 months, was 100% complete. THIRTY-DAY RESULTS: No conversions to open repair were necessary. Two patients died (10%), one of acute intestinal ischemia and the other because of multiorgan failure. Four patients showed endoleaks immediately after stenting. Two patients required new endovascular stentgrafts, while the remaining two were treated conservatively. Besides endoleaks, eight major complications occurred in six patients (two stroke, two paraplegia, two respiratory insufficiency, and one renal failure). MID-TERM RESULTS: Three more patients died during the follow-up period. One patient died of heart failure after a complicated postoperative course, 91 days after stenting. The second patient died because of aortic rupture, 139 days after stenting. The third patient died of heart failure, 15 months after the endovascular procedure. The remaining 16 patients are alive and have been regularly controlled by CT scans. No late migration or endoleaks have been detected. In all the survivors, the size of the aneurysm was unchanged or diminished.
Treatment of descending thoracic aortic aneurysms by endovascular stentgraft devices has good early and mid-term results. More accurate selection of patients may further reduce mortality and morbidity.
对于降主动脉真性动脉瘤，血管内支架移植物治疗是传统手术的一种有效替代方法。本文报告了我们连续21例患者的经验回顾，并讨论了技术方面的考虑因素。
1999年10月至2001年7月期间，对21例降主动脉真性动脉瘤（n = 14）或包含破裂（n = 7）的患者进行了治疗，患者平均年龄73岁。7例患者（33%）接受了急诊血管内手术。术后，在1、3、6和12个月时对患者进行CT扫描随访。平均随访17个月，随访率达100%。
30天结果：无需转为开放修复。2例患者死亡（10%），1例死于急性肠缺血，另1例死于多器官功能衰竭。4例患者在支架置入后立即出现内漏。2例患者需要新的血管内支架移植物，其余2例采用保守治疗。除内漏外，6例患者发生了8例主要并发症（2例中风、2例截瘫、2例呼吸功能不全和1例肾衰竭）。
随访期间又有3例患者死亡。1例患者在术后病程复杂后死于心力衰竭，支架置入后91天。第2例患者因主动脉破裂死亡，支架置入后139天。第3例患者在血管内手术后15个月死于心力衰竭。其余16例患者存活，并通过CT扫描定期进行检查。未检测到晚期移位或内漏。在所有存活患者中，动脉瘤大小未变或缩小。
血管内支架移植物装置治疗降主动脉瘤具有良好的早期和中期效果。更准确地选择患者可能会进一步降低死亡率和发病率。
