Anderson John L, Adam Donald J, Berce Michael, Hartley David E
Ashford Community Hospital, South Australia.
J Vasc Surg. 2005 Oct;42(4):600-7. doi: 10.1016/j.jvs.2005.05.063.
To report the repair of thoracoabdominal aortic aneurysms (TAAAs) with fenestrated and branched endovascular stent grafts (EVSGs).
Four patients with asymptomatic TAAAs were treated with custom-designed Zenith fenestrated and branched EVSGs. Three patients had undergone previous open aortic aneurysm repair. Thirteen visceral vessels in four patients were targeted for incorporation by graft fenestrations and branches.
The fenestration/orifice interface was secured with balloon-expandable Genesis stents or Jostent stent grafts in 9 of 13 target vessels. Completion angiography demonstrated antegrade perfusion in 12 of 13 target vessels. One renal artery occluded because of graft rotation during deployment. There were no endoleaks. Three patients required additional surgical procedures related to access vessels. One patient required reoperation for bleeding from an extra-anatomic bypass graft and subsequently died from multisystem organ failure. Three patients made an uncomplicated recovery. No patient developed spinal cord ischemia. Computed tomography at 12 months in the 3 survivors demonstrated complete aneurysm exclusion with antegrade perfusion in all 10 target vessels.
TAAA repair with fenestrated and branched EVSGs is feasible and provides an acceptable and promising alternative to conventional surgical repair in selected patients.
报告采用开窗和分支型血管内支架移植物（EVSG）修复胸腹主动脉瘤（TAAA）。
4例无症状TAAA患者接受了定制设计的Zenith开窗和分支型EVSG治疗。3例患者曾接受过开放性主动脉瘤修复术。4例患者的13支内脏血管通过移植物开窗和分支进行处理。
13支目标血管中的9支，其开窗/开口界面通过球囊扩张式Genesis支架或Jostent支架移植物固定。完成血管造影显示13支目标血管中有12支顺行灌注良好。1支肾动脉因输送过程中移植物旋转而闭塞。无内漏发生。3例患者需要进行与入路血管相关的额外手术。1例患者因解剖外旁路移植血管出血需要再次手术，随后死于多系统器官衰竭。3例患者恢复顺利。无患者发生脊髓缺血。3例存活患者术后12个月的计算机断层扫描显示动脉瘤完全被隔绝，所有10支目标血管均顺行灌注。
采用开窗和分支型EVSG修复TAAA是可行的，对于部分患者而言，是传统手术修复的一种可接受且有前景的替代方法。
