Lombardi Joseph V, Fairman Ronald M, Golden Michael A, Carpenter Jeffrey P, Mitchell Marc, Barker Clyde, McBride Amy, Velazquez Omaida C
Division of Vascular Surgery, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
J Vasc Surg. 2004 Jul;40(1):154-60. doi: 10.1016/j.jvs.2004.02.042.
Food and Drug Administration-approved endografts are suitable for the elective repair of abdominal aortic aneurysms (AAAs) with favorable aneurysm anatomy. Our aim is to illustrate the feasibility and versatility of commercially available endografts for emergency AAA repair in hemodynamically stable AAA rupture.
From June 2001 to July 2002, five patients presented with severe abdominal pain and were diagnosed with contained rupture of an infrarenal AAA. In all cases, patients were deemed unfit to withstand conventional open repair by both the referring outside medical center as well as our center's team. All patients were hemodynamically stable on arrival at our medical center. Measurement and selection of endovascular devices were based on computed tomography (CT) scans performed emergently at the outside referring center. The required emergently procured endografts were obtained within 2 to 4.5 hours (mean, 3.1 hours) of presentation. Complex anatomy at the proximal and distal fixation zones or difficult access was present in every case.
All patients survived endograft repair and had successful exclusion of their aneurysm sac on the basis of intraoperative arteriography and postoperative CT surveillance. All were discharged to home at baseline function within a mean of 6.8 days (range, 2-13 days). There were no deaths. There was one postoperative pulmonary embolism, one myocardial infarct, and one type 2 endoleak. Mean operative time and blood loss were 4.67 hours and 217 mL, respectively. At a mean follow-up of 18 months, CT scans showed stable or shrinking aneurysm sacs.
In patients with contained ruptured AAAs who present with hemodynamic stability and comorbidities that preclude open surgery, commercially available endografts are a versatile treatment option even in the face of complicated aneurysm anatomy.
美国食品药品监督管理局（FDA）批准的腔内移植物适用于对具有良好动脉瘤解剖结构的腹主动脉瘤（AAA）进行择期修复。我们的目的是说明市售腔内移植物用于血流动力学稳定的AAA破裂急诊修复的可行性和多功能性。
2001年6月至2002年7月，5例患者出现严重腹痛，被诊断为肾下腹主动脉瘤局限性破裂。在所有病例中，转诊的外部医疗中心以及我们中心的团队均认为患者不宜接受传统的开放修复手术。所有患者抵达我们医疗中心时血流动力学稳定。血管内装置的测量和选择基于外部转诊中心紧急进行的计算机断层扫描（CT）。所需的紧急采购的腔内移植物在就诊后2至4.5小时（平均3.1小时）内获得。每个病例均存在近端和远端固定区解剖结构复杂或入路困难的情况。
所有患者腔内移植物修复均存活，根据术中动脉造影和术后CT监测，动脉瘤囊成功被隔绝。所有患者均在平均6.8天（范围2 - 13天）内以基线功能出院回家。无死亡病例。术后发生1例肺栓塞、1例心肌梗死和1例Ⅱ型内漏。平均手术时间和失血量分别为4.67小时和217毫升。平均随访18个月时，CT扫描显示动脉瘤囊稳定或缩小。
对于局限性破裂的AAA患者，若血流动力学稳定且存在合并症而不能进行开放手术，即使面对复杂的动脉瘤解剖结构，市售腔内移植物也是一种多功能的治疗选择。
