Svensson Lars G, Kouchoukos Nicholas T, Miller D Craig, Bavaria Joseph E, Coselli Joseph S, Curi Michael A, Eggebrecht Holger, Elefteriades John A, Erbel Raimund, Gleason Thomas G, Lytle Bruce W, Mitchell R Scott, Nienaber Christoph A, Roselli Eric E, Safi Hazim J, Shemin Richard J, Sicard Gregorio A, Sundt Thoralf M, Szeto Wilson Y, Wheatley Grayson H
Center for Aortic Surgery and Marfan Syndrome Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Ann Thorac Surg. 2008 Jan;85(1 Suppl):S1-41. doi: 10.1016/j.athoracsur.2007.10.099.
Between 43,000 and 47,000 people die annually in the United States from diseases of the aorta and its branches and continues to increase. For the thoracic aorta, these diseases are increasingly treated by stent-grafting. No prospective randomized study exists comparing stent-grafting and open surgical treatment, including for disease subgroups. Currently, one stent-graft device is approved by the Food and Drug Administration for descending thoracic aortic aneurysms although two new devices are expected to obtain FDA approval in 2008. Stent-graft devices are used "off label" or under physician Investigational Device Exemption studies for other indications such as traumatic rupture of the aorta and aortic dissection. Early first-generation devices suffered from problems such as stroke with insertion, ascending aortic dissection or aortic penetration from struts, vascular injury, graft collapse, endovascular leaks, graft material failure, continued aneurysm expansion or rupture, and migration or kinking; however, the newer iterations coming to market have been considerably improved. Although the devices have been tested in pulse duplicators out to 10 years, long-term durability is not known, particularly in young patients. The long-term consequences of repeated computed tomography scans for checking device integrity and positioning on the risk of irradiation-induced cancer remains of concern in young patients. This document (1) reviews the natural history of aortic disease, indications for repair, outcomes after conventional open surgery, currently available devices, and insights from outcomes of randomized studies using stent-grafts for abdominal aortic aneurysm surgery, the latter having been treated for a longer time by stent-grafts; and (2) offers suggestions for treatment.
在美国，每年有43000至47000人死于主动脉及其分支疾病，且这一数字还在持续上升。对于胸主动脉疾病，越来越多地采用支架植入术进行治疗。目前尚无前瞻性随机研究比较支架植入术与开放手术治疗效果，包括针对疾病亚组的研究。目前，美国食品药品监督管理局仅批准了一种用于降主动脉瘤的支架植入器械，不过预计2008年将有另外两种新器械获得批准。支架植入器械还被“超适应证”使用，即在医生的研究器械豁免研究中用于其他适应证，如主动脉创伤性破裂和主动脉夹层。早期的第一代器械存在诸多问题，如插入时引发中风、升主动脉夹层或支柱穿透主动脉、血管损伤、移植物塌陷、血管内漏血、移植物材料故障、动脉瘤持续扩张或破裂以及移位或扭结等；然而，即将上市的新一代器械已有了显著改进。尽管这些器械在脉动模拟器中已测试长达10年，但长期耐用性尚不清楚，尤其是在年轻患者中。对于年轻患者而言，反复进行计算机断层扫描以检查器械完整性和位置，其对辐射诱发癌症风险的长期影响仍令人担忧。本文献（1）回顾了主动脉疾病的自然病程、修复指征、传统开放手术后的结局、现有器械以及使用支架植入术治疗腹主动脉瘤手术的随机研究结果（腹主动脉瘤采用支架植入术治疗的时间更长）；（2）并提出了治疗建议。
