Donas K P, Schulte S, Krause E, Horsch S
Department of Vascular Surgery, Porz am Rhein Hospital, Academic Teaching Hospital of the University of Cologne, Cologne, Germany.
Int Angiol. 2007 Sep;26(3):213-8.
This study demonstrates the therapeutic value of the hybrid open and endovascular procedure in anatomically challenging thoracoabdominal aortic aneurysms (TAAAs) in high-risk patients.
Between January 2000 and February 2006, 8 patients were treated with open visceral vessel revascularization and endovascular repair for TAAAs. Patient data were available from medical records. Pre- and postoperative physical examination, intra-arterial angiography, and spiral computed tomography scanning was performed in prearranged examinations.
A total of 28 visceral bypasses were performed in the 8 patients: 6 patients with complete visceral vessel revascularization and 2 with an aorto-mesenteric-celiac bypass. Aneurysm exclusion was achieved through the deployment of in total 23 stent-grafts. Seven out of the 8 procedures were conducted electively and one under urgent conditions. The mean follow-up period was 21 months. We recorded one procedure-related death due to postoperative hemorrhage resulting from diffuse retroperitoneal bleeding with consecutive multiorgan failure. Moreover, one patient developed acute renal insufficiency, but returned to normal values after temporary hemodialysis. Major adverse events included 2 cases of pneumonia and one myocardial infarction. Two reoperations were performed due to one mesenteric bypass occlusion and one groin hematoma. No neurological complications were observed.
The combined hybrid endovascular and open surgical approach in the treatment of complex TAAAs remains a feasible and effective operation technique. The less invasive character of the procedure and avoidance of aortic-cross clamping are clear advantages. Nevertheless, further study is mandatory to establish this alternative therapeutic option for complex TAAAs.
本研究证明了开放与血管腔内联合手术在高危患者解剖结构复杂的胸腹主动脉瘤（TAAA）治疗中的价值。
2000年1月至2006年2月期间，8例患者接受了开放内脏血管重建术和TAAA血管腔内修复术。患者数据可从病历中获取。在预先安排的检查中进行了术前和术后体格检查、动脉内血管造影和螺旋计算机断层扫描。
8例患者共进行了28次内脏旁路手术：6例患者实现了完全内脏血管重建，2例进行了主动脉-肠系膜-腹腔干旁路手术。通过总共植入23个支架型人工血管实现了动脉瘤隔绝。8例手术中有7例为择期手术，1例为急诊手术。平均随访期为21个月。我们记录了1例与手术相关的死亡，原因是弥漫性腹膜后出血导致术后出血并继发多器官功能衰竭。此外，1例患者出现急性肾功能不全，但在进行临时血液透析后恢复正常。主要不良事件包括2例肺炎和1例心肌梗死。因1例肠系膜旁路闭塞和1例腹股沟血肿进行了2次再次手术。未观察到神经并发症。
血管腔内与开放手术相结合的方法治疗复杂TAAA仍然是一种可行且有效的手术技术。该手术创伤较小且避免了主动脉阻断，具有明显优势。然而，仍需进一步研究以确立这种针对复杂TAAA的替代治疗方案。
