Czerny Martin, Grimm Michael, Zimpfer Daniel, Rodler Suzanne, Gottardi Roman, Hutschala Doris, Lammer Johannes, Wolner Ernst, Schoder Maria
Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria.
Ann Thorac Surg. 2007 Feb;83(2):450-5. doi: 10.1016/j.athoracsur.2006.08.031.
The purpose of this study was to determine durability and need for reinterventions after endovascular stent graft placement in atherosclerotic aneurysms involving the descending aorta.
We performed a prospective follow-up analysis of a consecutive series of 79 patients undergoing endovascular stent graft placement due to atherosclerotic aneurysms involving the descending aorta between 1996 and 2006. Acute aortic syndromes were excluded from this analysis. Mean follow-up was 42 months (range, 1 to 108 months). Data were collected for in-hospital mortality, occurrence of early and late endoleaks, reintervention due to early and late endoleaks, and survival.
In-hospital mortality was 6.3% (n = 5). Two of these patients underwent emergent treatment. Early type I and III endoleaks were observed in 29% of patients (n = 23). The assisted primary endoleak rate was 11%. Late type I or III endoleaks occurred in 21% (n = 17). At 1, 3, and 5 years, overall actuarial survival was 96%, 86%, and 69%, and event-free survival was 90%, 82%, and 65%, respectively. Cox proportional hazard analysis revealed that a short proximal landing zone and a high number of stent grafts used were independent risk factors for early and late endoleak formation. Late endoleak formation was an independent predictor of survival.
Endovascular stent graft placement in atherosclerotic aneurysms involving the descending aorta has satisfactory durability. An extensive landing zone is a prerequisite of early and late success. Further clinical investigations are warranted to evaluate long-term durability of this attractive treatment modality.
本研究的目的是确定在涉及降主动脉的动脉粥样硬化性动脉瘤中，血管内支架植入术后的耐久性以及再次干预的必要性。
我们对1996年至2006年间因涉及降主动脉的动脉粥样硬化性动脉瘤而接受血管内支架植入的79例连续患者进行了前瞻性随访分析。本分析排除了急性主动脉综合征。平均随访时间为42个月（范围为1至108个月）。收集了住院死亡率、早期和晚期内漏的发生情况、因早期和晚期内漏进行的再次干预以及生存率的数据。
住院死亡率为6.3%（n = 5）。其中2例患者接受了紧急治疗。29%的患者（n = 23）观察到早期I型和III型内漏。辅助原发性内漏率为11%。晚期I型或III型内漏发生在21%（n = 17）的患者中。在1年、3年和5年时，总体精算生存率分别为96%、86%和69%，无事件生存率分别为90%、82%和65%。Cox比例风险分析显示，近端锚定区短和使用的支架数量多是早期和晚期内漏形成的独立危险因素。晚期内漏形成是生存的独立预测因素。
在涉及降主动脉的动脉粥样硬化性动脉瘤中进行血管内支架植入具有令人满意的耐久性。广泛的锚定区是早期和晚期成功的先决条件。有必要进行进一步的临床研究以评估这种有吸引力的治疗方式的长期耐久性。
