Kotelis D, Geisbüsch P, von Tengg-Kobligk H, Allenberg J-R, Böckler D
Klinik für Gefässchirurgie, Vaskuläre und Endovaskuläre Chirurgie, Chirurgische Universitätsklinik Heidelberg.
Zentralbl Chir. 2008 Aug;133(4):338-43. doi: 10.1055/s-2008-1076903.
The aim of this study was to analyse the incidence and aetiology of paraplegia secondary to endovascular repair of the thoracic and thoracoabdominal aorta (TEVAR).
A retrospective study was conducted in the patients treated at our facility between March 1997 and April 2007. During this interval, 173 patients (163 men; median age: 62 years) underwent endovascular repair of the thoracic aorta. Indications for treatment were thoracic aortic aneurysms in 36 patients, thoracoabdominal aortic aneurysms in 33 patients, type B dissections in 43 patients, type A dissections in 5 patients, penetrating aortic ulcers in 31 patients, traumatic aortic transections in 9 patients, post-traumatic aortic aneurysms in 5 patients, aortobronchial fistulas in 8 patients, aortic patch ruptures in 2 patients, and an anastomotic aortic aneurysm in 1 patient. 101 procedures (58%) were conducted as emergency interventions while 72 were elective. Device design and implant strategy were chosen on the basis of an evaluation of morphology from a computed tomographic scan. Clinical assessment and imaging of the aorta (CT or magnetic resonance imaging) during follow up were performed prior to discharge, at 6 and 12 months, and then annually.
A primary technical success was achieved in 170 patients (98%). The overall 30-day mortality rate was 9.2%. Length of follow-up ranged from 1 to 96 months, with a mean of 52 months. Paraplegia or paraparesis developed in 3 patients (1.7%). Two of these patients had a thoracoabdominal aortic aneurysm and the third a chronic expanding type B dissection, being treated with hybrid procedures.
Endovascular repair of the thoracic and thoracoabdominal aorta is associated with a relatively low risk for postoperative paraplegia or paraparesis. Patients requiring long segment aortic coverage, and with prior aortic replacement are especially at risk.
本研究旨在分析胸主动脉和胸腹主动脉腔内修复术（TEVAR）后继发截瘫的发生率及病因。
对1997年3月至2007年4月在我院接受治疗的患者进行回顾性研究。在此期间，173例患者（163例男性；中位年龄：62岁）接受了胸主动脉腔内修复术。治疗指征包括36例胸主动脉瘤、33例胸腹主动脉瘤、43例B型夹层、5例A型夹层、31例穿透性主动脉溃疡、9例创伤性主动脉横断、5例创伤后主动脉瘤、8例主动脉支气管瘘、2例主动脉补片破裂以及1例吻合口主动脉瘤。101例手术（58%）为急诊干预，72例为择期手术。根据计算机断层扫描的形态学评估选择器械设计和植入策略。随访期间，在出院前、6个月和12个月以及之后每年进行主动脉的临床评估和影像学检查（CT或磁共振成像）。
170例患者（98%）获得了初步技术成功。30天总死亡率为9.2%。随访时间为1至96个月，平均52个月。3例患者（1.7%）发生了截瘫或轻瘫。其中2例患者患有胸腹主动脉瘤，第3例为慢性扩张型B型夹层，均接受了杂交手术治疗。
胸主动脉和胸腹主动脉腔内修复术术后截瘫或轻瘫的风险相对较低。需要长节段主动脉覆盖且既往有主动脉置换史的患者尤其危险。
