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胸主动脉疾病的血管内治疗:来自欧洲血管内支架移植物治疗主动脉瘤注册研究(EUROSTAR)和英国胸主动脉内支架移植物注册研究的联合经验

Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries.

作者信息

Leurs Lina J, Bell Rachel, Degrieck Yvan, Thomas Steve, Hobo Roel, Lundbom Jan

机构信息

EUROSTAR and UK Thoracic Aortic Data Registry, Catharina Hospital, Eindhoven, The Netherlands.

出版信息

J Vasc Surg. 2004 Oct;40(4):670-9; discussion 679-80. doi: 10.1016/j.jvs.2004.07.008.

Abstract

PURPOSE

The objective of this study was to assess the initial and 1-year outcome of endovascular treatment of thoracic aortic aneurysms and dissections collated in the European Collaborators on Stent Graft Techniques for Thoracic Aortic Aneurysm and Dissection Repair (EUROSTAR) and the United Kingdom Thoracic Endograft registries.

METHODS

Four hundred forty-three patients underwent endovascular repair of thoracic aortic disease between September 1997 and August 2003 (EUROSTAR, 340 patients; UK, 103 patients). Patients represented 4 major disease groups: degenerative aneurysm (n = 249), aortic dissection (n = 131), false anastomotic aneurysm (n = 13), and traumatic aortic injury (n = 50).

RESULTS

Mean age in the entire study group was 63 years. Fifty-two percent of patients were deemed at high risk for open surgery because of major comorbidity. Sixty percent of patients underwent an elective procedure, and 35% required emergency treatment. Conventional indications for treatment of aortic dissection, including aortic expansion, continuous pain, rupture, or symptoms of branch occlusion constituted the basis for endograft placement in 57% of patients, whereas in 43% of patients aortic dissections were asymptomatic. Primary technical success was obtained in 87% of patients with degenerative aneurysm and in 89% with aortic dissection. Paraplegia was a postoperative complication in 4.0% of patients with degenerative aneurysm and 0.8% of patients with aortic dissection (not significant). Thirty-day mortality in the entire study group was 9.3%, with mortality rates after elective procedures of 5.3% for degenerative aneurysms and 6.5% for aortic dissection. Mortality for degenerative aneurysm after emergency repair was higher (28%; P <.0001) then after elective procedures. For aortic dissection the emergency repair rate was 12% (not significant compared with elective repair of aortic dissection, and P = .025 compared with emergency repair of degenerative aneurysm). One-year follow-up was complete in 195 patients. The outcome at 1 year was more favorable for aortic dissection than for degenerative aneurysm with regard to aortic expansion (0% vs 15%; P = .001) and late survival (90% vs 80%; P = .048). In the groups with false anastomotic aneurysm and traumatic aortic injury, 30-day mortality rates were 8% and 6%, respectively.

CONCLUSION

This multicenter experience demonstrates acceptable rates for operative mortality and paraplegia after endovascular repair of thoracic aortic disease. Outcome after 30 days and 1 year was more favorable for aortic dissection than for degenerative aneurysm. However, the durability of this technique is currently unknown, and continued use of registries should provide data from long-term follow-up.

摘要

目的

本研究的目的是评估在欧洲胸主动脉瘤和夹层支架移植物技术协作组(EUROSTAR)及英国胸内支架植入登记处汇总的胸主动脉瘤和夹层的血管内治疗的初始及1年结果。

方法

1997年9月至2003年8月期间,443例患者接受了胸主动脉疾病的血管内修复(EUROSTAR组340例患者;英国组103例患者)。患者分为4个主要疾病组:退行性动脉瘤(n = 249)、主动脉夹层(n = 131)、假性吻合口动脉瘤(n = 13)和创伤性主动脉损伤(n = 50)。

结果

整个研究组的平均年龄为63岁。52%的患者因严重合并症被认为进行开放手术的风险较高。60%的患者接受了择期手术,35%的患者需要急诊治疗。主动脉夹层治疗的传统指征,包括主动脉扩张、持续疼痛、破裂或分支闭塞症状,是57%患者植入血管内支架的依据,而43%的患者主动脉夹层无症状。退行性动脉瘤患者的主要技术成功率为87%,主动脉夹层患者为89%。截瘫是退行性动脉瘤患者4.0%和主动脉夹层患者0.8%的术后并发症(无显著性差异)。整个研究组的30天死亡率为9.3%,退行性动脉瘤择期手术后的死亡率为5.3%,主动脉夹层为6.5%。退行性动脉瘤急诊修复后的死亡率高于择期手术后(28%;P <.0001)。对于主动脉夹层,急诊修复率为12%(与主动脉夹层择期修复相比无显著性差异,与退行性动脉瘤急诊修复相比P = 0.025)。195例患者完成了1年随访。在主动脉扩张方面(0%对15%;P = 0.001)和晚期生存率方面(90%对80%;P = 0.048),主动脉夹层1年时的结果比退行性动脉瘤更有利。在假性吻合口动脉瘤和创伤性主动脉损伤组中,30天死亡率分别为8%和6%。

结论

这项多中心经验表明,胸主动脉疾病血管内修复术后的手术死亡率和截瘫发生率是可接受的。30天和1年时,主动脉夹层的结果比退行性动脉瘤更有利。然而,该技术的耐久性目前尚不清楚,继续使用登记处应能提供长期随访的数据。

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