Wheatley Grayson H, Nunez Anthony, Preventza Ourania, Ramaiah Venkatesh G, Rodriguez-Lopez Julio A, Williams James, Olsen Dawn, Diethrich Edward B
Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, Ariz 85006, USA.
J Thorac Cardiovasc Surg. 2007 May;133(5):1277-85. doi: 10.1016/j.jtcvs.2006.11.066. Epub 2007 Mar 28.
Although endovascular repair of the descending thoracic aorta has emerged as a viable treatment option, little is known about its potential to treat patients diagnosed with aortobronchial fistulas. We reviewed our comprehensive thoracic endografting experience with regard to the endovascular management and subsequent outcome of patients with aortobronchial fistulas to assess whether endoluminal graft repair is a realistic option.
Between February 2000 and November 2005, 255 patients were successfully treated with an endoluminal graft to the descending thoracic aorta. Indications for intervention included: atherosclerotic aneurysms (109/255, 42.7%), acute and chronic dissections (75/255, 29.4%), miscellaneous (34/255, 13.3%), penetrating aortic ulcers (30/255, 11.8%), and aortobronchial fistulas (7/255, 2.7%).
Average patient age was 73.4 +/- 10.1 years, with 4 male patients (4/7, 57.1%) and 3 female patients (3/7, 42.9%). All patients presented with hemoptysis, with 1 patient (1/7, 14.3%) requiring preoperative blood transfusion. Three patients (3/7, 42.9%) were diagnosed with atherosclerotic aneurysms, 3 patients (3/7, 42.9%) had pseudoaneurysms associated with prior open surgical repair, and 1 patient (1/7, 14.3%) had a prior endoluminal graft placed for a traumatic aortic transection. No standard postoperative antibiotic regimen was followed. There were no endoleaks, no incidences of paraplegia, and no endoluminal graft infections. Survival was 100% (7/7) at both 30 days and 1 year, and all patients are currently alive. Follow-up computed tomography was available for all 7 patients, with an average follow-up of 42.6 +/- 28.5 months.
Endovascular management of aortobronchial fistulas appears to be safe and well tolerated, even in surgically high-risk patients, with minimal risk of prosthesis infection. Long-term surveillance and continued investigation are warranted.
尽管胸降主动脉的血管腔内修复已成为一种可行的治疗选择，但对于其治疗主动脉支气管瘘患者的潜力知之甚少。我们回顾了我们在主动脉支气管瘘患者的血管腔内治疗及后续结果方面的综合胸段血管腔内修复经验，以评估腔内移植物修复是否是一种现实的选择。
2000年2月至2005年11月期间，255例患者成功接受了胸降主动脉腔内移植物治疗。干预指征包括：动脉粥样硬化性动脉瘤（109/255，42.7%）、急慢性夹层（75/255，29.4%）、其他（34/255，13.3%）、穿透性主动脉溃疡（30/255，11.8%）和主动脉支气管瘘（7/255，2.7%）。
患者平均年龄为73.4±10.1岁，男性4例（4/7，57.1%），女性3例（3/7，42.9%）。所有患者均有咯血症状，1例患者（1/7，14.3%）术前需要输血。3例患者（3/7，42.9%）被诊断为动脉粥样硬化性动脉瘤，3例患者（3/7，42.9%）有与先前开放手术修复相关的假性动脉瘤，1例患者（1/7，14.3%）先前因创伤性主动脉横断放置了腔内移植物。未遵循标准的术后抗生素治疗方案。无内漏、无截瘫发生，也无腔内移植物感染。30天和1年时生存率均为100%（7/7），所有患者目前均存活。7例患者均有随访计算机断层扫描，平均随访时间为42.6±28.5个月。
即使在手术高危患者中，主动脉支气管瘘患者中，血管腔内治疗似乎也是安全且耐受性良好的，假体感染风险极小。有必要进行长期监测和持续研究。
