Gilling-Smith G L, McWilliams R G, Scurr J R H, Brennan J A, Fisher R K, Harris P L, Vallabhaneni S R
Regional Vascular Unit, Royal Liverpool University Hospital, Liverpool, UK.
Br J Surg. 2008 Jun;95(6):703-8. doi: 10.1002/bjs.6179.
The aim was to evaluate a wholly endovascular approach to the repair of thoracoabdominal aortic aneurysm (TAAA).
Six patients (median age 71 years) underwent wholly endovascular repair of TAAA (maximum diameter 56-85 mm) employing individually customized endografts. Procedures were performed under general anaesthesia, with spinal drainage in five patients. Patients were followed by serial computed tomography, plain radiography and duplex imaging for a median of 17 (range 8-44) months.
All grafts were deployed as intended, with preservation of all target vessels. There were no postoperative deaths, strokes or paraplegia. One patient suffered a silent myocardial infarction. In two patients a persistent paraostial endoleak was treated by further balloon dilatation of the stent within the endograft fenestration. Imaging before discharge confirmed aneurysm exclusion in all patients. Two patients required late secondary intervention to abolish endoleaks due to side-branch disconnection. One patient suffered late occlusion of the coeliac axis without clinical sequelae, and late occlusion of a solitary renal artery in another resulted in dependence on dialysis. There have been no late deaths and all aneurysms remain excluded.
Wholly endovascular TAAA repair is relatively safe, but long-term follow-up is required to establish its durability.
目的是评估一种完全血管内方法修复胸腹主动脉瘤（TAAA）。
6例患者（中位年龄71岁）采用个体化定制的腔内移植物对TAAA（最大直径56 - 85mm）进行完全血管内修复。手术在全身麻醉下进行，5例患者进行了脊髓引流。通过系列计算机断层扫描、X线平片和双功成像对患者进行随访，中位随访时间为17（8 - 44）个月。
所有移植物均按预期植入，所有靶血管均得以保留。无术后死亡、卒中或截瘫发生。1例患者发生无症状性心肌梗死。2例患者通过对腔内移植物开窗处支架进一步球囊扩张治疗持续性吻合口周围内漏。出院前影像学检查证实所有患者动脉瘤均被隔绝。2例患者因分支血管断开需后期二次干预以消除内漏。1例患者发生腹腔干晚期闭塞但无临床后遗症，另1例患者单支肾动脉晚期闭塞导致依赖透析。无晚期死亡病例，所有动脉瘤均仍保持隔绝状态。
完全血管内修复TAAA相对安全，但需要长期随访以确定其耐久性。
