Gerassimidis Thomas S, Papazoglou Konstantinos O, Kamparoudis Apostolos G, Konstantinidis Konstantinos, Karkos Christos D, Karamanos Dimitrios, Sfyroeras Georgios
Fifth Surgical Clinic, Medical School, Aristotle University of Thessaloniki, Ippokratio Hospital, Greece.
J Vasc Surg. 2005 Oct;42(4):615-23; discussion 623. doi: 10.1016/j.jvs.2005.05.061.
To report our early experience with endovascular treatment of patients with ruptured abdominal aortic aneurysms (RAAAs).
Between March 1998 and October 2004, 40 consecutive patients with an RAAA presented to our unit; 38 underwent assessment by computed tomography, whereas 2 died on arrival before any assessment and treatment was possible. Twenty-three patients (61%) were suitable for stent grafting, and all proceeded to endovascular repair. Of these, 17 underwent operation with local anesthesia, 1 did so under general anesthesia, and a further 5 procedures were commenced under local anesthesia and converted to general anesthesia. A total of 14 bifurcated and 10 aortouni-iliac stent grafts were implanted; in 1 patient, the bifurcated graft was converted to an aortouni-iliac repair during surgery because of technical difficulties.
Stent-graft deployment in the intended location without a type I or III endoleak was technically successful in 22 of the 23 patients. There were no conversions to open surgery. The 30-day mortality was 39%. Six patients died immediately or soon after the procedure because of severe hypovolemic shock, and three died within 30 days from cardiac causes. After surgery, 13 complications were encountered in 10 patients (3 cardiac, 4 respiratory, 5 renal, and 1 implant related). Two patients required reintervention--one for a type I endoleak and one for limb occlusion. There were 14 survivors. During a median follow-up of 410 days (range, 90-1650 days), 2 more patients died from myocardial infarction, and 9 remain well; 3 patients were lost to follow-up. There were three secondary interventions (two for type I endoleak and one for stent-graft thrombosis).
Endovascular treatment of RAAAs is feasible, and the early experience is promising. More experience and evidence from randomized trials are needed to determine whether such an approach is superior to open surgery.
报告我们对破裂腹主动脉瘤（RAAA）患者进行血管内治疗的早期经验。
1998年3月至2004年10月期间，40例连续的RAAA患者前来我院就诊；38例接受了计算机断层扫描评估，2例在到达时死亡，无法进行任何评估和治疗。23例患者（61%）适合进行支架植入，均接受了血管内修复。其中，17例在局部麻醉下进行手术，1例在全身麻醉下进行，另有5例手术最初在局部麻醉下开始，随后转为全身麻醉。共植入14个分叉型和10个主动脉单髂型支架；1例患者因技术困难，在手术中将分叉型移植物改为主动脉单髂型修复。
23例患者中有22例在预定位置成功部署支架移植物，无I型或III型内漏，技术成功。无转为开放手术的情况。30天死亡率为39%。6例患者在手术后立即或不久因严重低血容量性休克死亡，3例在30天内死于心脏原因。术后，10例患者出现13种并发症（3种心脏并发症、4种呼吸并发症、5种肾脏并发症和1种植入相关并发症）。2例患者需要再次干预——1例因I型内漏，1例因肢体闭塞。有14例幸存者。在中位随访410天（范围90 - 1650天）期间，又有2例患者死于心肌梗死，9例情况良好；3例患者失访。有3次二次干预（2次因I型内漏，1次因支架移植物血栓形成）。
RAAA的血管内治疗是可行的，早期经验令人鼓舞。需要更多的经验和随机试验证据来确定这种方法是否优于开放手术。
