Marin Michael L, Hollier Larry H, Ellozy Sharif H, Spielvogel David, Mitty Harold, Griepp Randall, Lookstein Robert A, Carroccio Alfio, Morrissey Nicholas J, Teodorescu Victoria J, Jacobs Tikva S, Minor Michael E, Sheahan Claudie M, Chae Kristina, Oak Juliana, Cha Andrew
Departments of Surgery, Mount Sinai of Medicine, New York, NY 10029, USA.
Ann Surg. 2003 Oct;238(4):586-93; discussion 593-5. doi: 10.1097/01.sla.0000090473.63393.e9.
On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was performed in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients.
Abdominal (AAA) or thoracic (TAA) aortic aneurysms are a significant health concern traditionally treated by open surgical repair. ESG therapy may offer protection from aneurysm rupture with a reduction in procedure morbidity and mortality.
Over a 10-year period, 817 patients were treated with ESGs for AAA (723) or TAA (94). Patients received 1 of 12 different stent graft devices. Technical and clinical success of ESGs was reviewed, and the incidence of procedure-related complications was analyzed.
The mean age was 74.3 years (range, 25-95 years); 678 patients (83%) were men; 86% had 2 or more comorbid medical illnesses, 67% of which included coronary artery disease. Technical success, on an intent-to-treat basis was achieved in 93.8% of patients. Primary clinical success, which included freedom from aneurysm-related death, type I or III endoleak, graft infection or thrombosis, rupture, or conversion to open repair was 65 +/- 6% at 8 years. Of great importance, freedom from aneurysm rupture after ESG insertion was 98 +/- 1% at 9 years. There was a 2.3% incidence of perioperative mortality. One hundred seventy five patients died of causes not related to their aneurysm during a mean follow-up of 15.4 months.
Stent graft therapy for aortic aneurysms is a valuable alternative to open aortic repair, especially in older sicker patients with large aneurysms. Continued device improvements coupled with an enhanced understanding of the important role of aortic pathology in determining therapeutic success will eventually permit ESGs to be a more durable treatment of aortic aneurysms.
1992年11月23日，北美首例腹主动脉瘤血管内支架移植物（ESG）修复手术完成。自该患者接受治疗后，在过去10年里我们持续对817例患者的ESG治疗情况进行评估。
腹主动脉瘤（AAA）或胸主动脉瘤（TAA）是严重的健康问题，传统上通过开放手术修复治疗。ESG治疗可能预防动脉瘤破裂，同时降低手术发病率和死亡率。
在10年期间，817例患者接受了用于AAA（723例）或TAA（94例）的ESG治疗。患者使用了12种不同支架移植物装置中的一种。回顾了ESG的技术和临床成功率，并分析了手术相关并发症的发生率。
平均年龄为74.3岁（范围25 - 95岁）；678例患者（83%）为男性；86%的患者有2种或更多种合并内科疾病，其中67%包括冠状动脉疾病。基于意向性治疗分析，93.8%的患者获得技术成功。主要临床成功率（包括无动脉瘤相关死亡、I型或III型内漏、移植物感染或血栓形成、破裂或转为开放修复）在8年时为65±6%。非常重要的是，ESG植入后9年时无动脉瘤破裂率为98±1%。围手术期死亡率为2.3%。在平均15.4个月的随访期间，175例患者死于与动脉瘤无关的原因。
主动脉瘤的支架移植物治疗是开放主动脉修复的一种有价值的替代方法，尤其对于患有大动脉瘤的老年体弱患者。持续的装置改进以及对主动脉病理学在决定治疗成功中的重要作用的更深入理解，最终将使ESG成为治疗主动脉瘤更持久的方法。
