Carroccio Alfio, Spielvogel David, Ellozy Sharif H, Lookstein Robert A, Chin Iris Y, Minor Michael E, Sheahan Claudie M, Teodorescu Victoria J, Griepp Randall B, Marin Michael L
Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA.
Vascular. 2005 Jan-Feb;13(1):5-10. doi: 10.1258/rsmvasc.13.1.5.
Reconstruction of aortic arch and descending thoracic aortic aneurysms (TAAs) is technically challenging and associated with significant morbidity and mortality. We report our experience with extensive TAAs using a two-stage "elephant trunk" repair, with the second stage completed using an endovascular stent graft (ESG). Over 6 years, 111 patients underwent ESG treatment of TAAs at Mount Sinai Medical Center. Twelve of these patients were referred for ESG placement for the second stage of elephant trunk reconstruction because comorbidities placed them at high risk of open surgical repair. Our database was analyzed for technical and clinical success and perioperative complications. The mean follow-up was 11.8 months (range 1-64 months). Twelve patients (five women and seven men) with a mean age of 69 +/- 10 years underwent repair of their distal aortic arch and descending TAAs. These aneurysms included nine atherosclerotic aneurysms, one pseudoaneurysm, and two penetrating atherosclerotic ulcers. Three patients were symptomatic. Stent graft repair was technically successful in 91.7% or 11 of 12 patients. Excessive aortic arch tortuosity resulted in failure to deploy a stent graft in one patient. An antegrade approach through the open elephant trunk was used in two patients with severe iliac occlusive disease. Endoleaks (type 2) were identified in two patients with no aneurysm expansion; however, a 14 mm expansion over 1 year occurred in a patient with no identifiable endoleak. One early mortality occurred in a patient with a ruptured 6 cm infrarenal AAA after successful exclusion of the 8 cm TAA. Second-stage elephant trunk reconstruction of an extensive TAA using an ESG is effective in the short term. Its long-term durability remains to be determined.
主动脉弓及降胸主动脉瘤（TAA）的重建在技术上具有挑战性，且与显著的发病率和死亡率相关。我们报告了我们使用两阶段“象鼻”修复术治疗广泛TAA的经验，第二阶段使用血管内支架移植物（ESG）完成。在6年多的时间里，111例患者在西奈山医疗中心接受了TAA的ESG治疗。其中12例患者因合并症使其面临开放手术修复的高风险而被转诊接受ESG置入，作为象鼻重建的第二阶段。我们分析了我们的数据库，以了解技术和临床成功率以及围手术期并发症。平均随访时间为11.8个月（范围1 - 64个月）。12例患者（5名女性和7名男性）平均年龄为69±10岁，接受了远端主动脉弓和降TAA的修复。这些动脉瘤包括9例动脉粥样硬化性动脉瘤、1例假性动脉瘤和2例穿透性动脉粥样硬化溃疡。3例患者有症状。支架移植物修复在91.7%（12例中的11例）的患者中技术成功。1例患者因主动脉弓过度迂曲导致支架移植物未能展开。2例患有严重髂动脉闭塞性疾病的患者采用了经开放象鼻的顺行入路。2例患者发现有内漏（2型），动脉瘤无扩大；然而，1例未发现可识别内漏的患者在1年内动脉瘤扩大了14 mm。1例患者在成功排除8 cm的TAA后，6 cm肾下AAA破裂，发生了1例早期死亡。使用ESG进行广泛TAA的二期象鼻重建在短期内是有效的。其长期耐久性仍有待确定。
