Iyer Vikram S, Mackenzie Kent S, Tse Leonard W, Abraham Cherrie Z, Corriveau Marc-Michel, Obrand Daniel I, Steinmetz Oren K
Division of Vascular Surgery, McGill University, Montréal, Québec, Canada.
J Vasc Surg. 2006 Apr;43(4):677-83. doi: 10.1016/j.jvs.2005.12.001.
Endovascular treatment of thoracic aortic pathology has emerged as a viable alternative to open surgical repair in both the elective and emergent settings. The aim of this study was to evaluate preoperative work-up, intra-operative strategy, and outcomes of endovascular stent-grafting of the thoracic aorta in patients undergoing elective repair and those undergoing emergent repair.
All patient information was obtained by a retrospective review of an established clinical database for all endovascular thoracic stent-graft cases. From October 1999 to August 2005, 70 patients were treated with endovascular stent-grafts for lesions of the thoracic aorta. Thirty-five patients had an elective endovascular procedure, and 35 patients had an emergent procedure.
Thirty-five patients in the endovascular (EL) group were treated for aneurysm (n = 34) and type B dissection (n = 1). Thirty-five patients in the emergent (EM) group were treated for aneurysm (n = 10), intramural hematoma (n = 10), type B dissection (n = 7), traumatic rupture (n = 7), and aortoesophageal fistula (n = 1). Preoperative angiography was performed in 94.3% (33/35) of EL patients but in only 45.7% (16/35) EM patients (P < .005). The EM procedures had significantly shorter operative times, used lower contrast volumes, used fewer stent-graft components (mode 2, range 1 to 5 vs mode 1, range 1 to 3; P = .02), and spinal cerebrospinal fluid drains were used significantly less often (82.9% vs 57.1%, P = .04). Both groups had similar 30-day morbidity, mortality (0/35 EL vs 1/35 [2.9%] EM, P = .99), postoperative endoleak (9/35 [25.7%] EL vs 7/35 [20.0%] EM, P = .78), endovascular failure (3/35 [8.6%] EL vs 5/35 [14.3%] EM, P = .71), and patient survival.
There are significant differences in the underlying pathology, preoperative evaluation, and operative course between elective and emergency treatment endovascular procedures for lesions of the thoracic aorta. Endovascular repair of thoracic aortic lesions can be accomplished with low perioperative mortality and morbidity rates, as well as acceptable endoleak and endovascular failure rates for both elective and emergency procedures.
在择期和急诊情况下，胸主动脉病变的血管内治疗已成为开放性手术修复的一种可行替代方案。本研究的目的是评估接受择期修复和急诊修复的患者胸主动脉血管内支架植入术的术前检查、术中策略及结果。
通过回顾一个已建立的所有血管内胸主动脉支架病例的临床数据库来获取所有患者信息。1999年10月至2005年8月，70例患者接受了胸主动脉病变的血管内支架植入治疗。35例患者接受了择期血管内手术，35例患者接受了急诊手术。
血管内（EL）组的35例患者接受了动脉瘤（n = 34）和B型夹层（n = 1）的治疗。急诊（EM）组的35例患者接受了动脉瘤（n = 10）、壁内血肿（n = 10）、B型夹层（n = 7）、创伤性破裂（n = 7）和主动脉食管瘘（n = 1）的治疗。94.3%（33/35）的EL组患者进行了术前血管造影，而EM组患者仅45.7%（16/35）进行了术前血管造影（P <.005）。急诊手术的手术时间明显更短，造影剂用量更低，使用的支架组件更少（模式2，范围1至5对比模式1，范围1至3；P =.02），并且脊髓脑脊液引流的使用频率明显更低（82.9%对比57.1%，P =.04）。两组的30天发病率、死亡率（EL组0/35对比EM组1/35 [2.9%]，P =.99）、术后内漏（EL组9/35 [25.7%]对比EM组7/35 [20.0%]，P =.78）、血管内治疗失败率（EL组3/35 [8.6%]对比EM组5/35 [14.3%]，P =.71）及患者生存率相似。
胸主动脉病变的择期和急诊血管内治疗在基础病理、术前评估及手术过程方面存在显著差异。胸主动脉病变的血管内修复可以实现较低的围手术期死亡率和发病率，以及对于择期和急诊手术均可接受的内漏和血管内治疗失败率。
