Morales J P, Chan Y C, Bell R E, Reidy J F, Taylor P R
Department of Vascular Surgery, Guy's & St. Thomas' NHS Foundation Hospital, St. Thomas' Hospital, London, UK.
Int J Clin Pract. 2008 Oct;62(10):1511-4. doi: 10.1111/j.1742-1241.2006.01282.x. Epub 2007 May 30.
We have evaluated the efficacy of endovascular repair of distal aortic arch aneurysms (DAAA) causing recurrent laryngeal nerve palsy.
Eight patients (five male and three female) with median age of 72 years (range: 59-80) presented with left recurrent laryngeal nerve palsy associated with DAAA. All patients were considered unfit for open surgery. The median aneurysm size was 5.9 cm (range: 5-7.3). Thirteen stents were deployed: eight Gore, four Endofit and one Talent. Epidural anaesthesia was used in all patients. The left subclavian artery was covered in all and the left common carotid in three who had a preliminary right to left carotid-carotid bypass. Routine follow-up (FU) was with computed tomography (CT) at 3-6 months and yearly thereafter.
Exclusion of the aneurysm sac was achieved in all patients. Thirty-day mortality was 0%, with no paraplegia or stroke. Early complications included: rupture of the external iliac artery (one) and common femoral artery thrombectomy (one). One patient died of unknown cause at 17 months. The mean FU in the remaining seven patients was 21 months (range: 6-51). Aneurysm size decreased in five, was unchanged in one and increased in one. Three patients had improvement in voice quality postoperatively. One patient had a recurrent type 1 endoleak which was restented twice. No late deaths have occurred.
Though technically the procedures involved were more complicated, endovascular repair of DAAA causing aorto-vocal syndrome is safe and offers a realistic alternative to open surgery. Hoarseness of the voice can improve postoperatively and is associated with reduction in aortic sac diameter.
我们评估了血管腔内修复导致喉返神经麻痹的远端主动脉弓动脉瘤（DAAA）的疗效。
8例患者（5例男性，3例女性），中位年龄72岁（范围：59 - 80岁），表现为与DAAA相关的左侧喉返神经麻痹。所有患者均被认为不适合接受开放手术。动脉瘤中位大小为5.9 cm（范围：5 - 7.3）。共植入13枚支架：8枚戈尔支架、4枚Endofit支架和1枚泰伦特支架。所有患者均采用硬膜外麻醉。所有患者均覆盖左锁骨下动脉，3例在先行右向左颈动脉 - 颈动脉搭桥的患者中覆盖左颈总动脉。常规随访（FU）在术后3 - 6个月进行计算机断层扫描（CT）检查，此后每年检查一次。
所有患者的动脉瘤囊均被排除。30天死亡率为0%，无截瘫或中风发生。早期并发症包括：髂外动脉破裂（1例）和股总动脉血栓切除术（1例）。1例患者在17个月时死于不明原因。其余7例患者的平均随访时间为21个月（范围：6 - 51个月）。5例患者的动脉瘤大小减小，1例不变，1例增大。3例患者术后声音质量有所改善。1例患者出现复发性I型内漏，再次植入支架2次。无晚期死亡病例发生。
尽管所涉及的手术在技术上更为复杂，但血管腔内修复导致主动脉 - 嗓音综合征的DAAA是安全的，为开放手术提供了一种切实可行的替代方案。术后声音嘶哑可改善，且与主动脉瘤囊直径减小有关。
