Ferreira Marcelo, Lanziotti Luiz, Monteiro Marcelo
Serviço Integrado de Técnicas Endovasculares (SITE, Endovascular Techniques Integrated Service), Rio de Janeiro, Brazil.
J Vasc Surg. 2008 Dec;48(6 Suppl):30S-36S; discussion 36S. doi: 10.1016/j.jvs.2008.08.096.
This study reports the initial clinical results and experience with the planning of branched stent grafts in high-risk patients with thoracoabdominal aortic aneurysms (TAAAs).
High-risk patients with TAAAs were considered for this study. Based on evaluation with computed tomography angiography (CTA), 21 custom-made branched stent grafts were designed for the selected patients. Two patients had associated bilateral aneurysms of the common iliac arteries, so an iliac branched device was also used.
Between August 2006 and April 2008, 23 patients (10 women, 13 men) were selected to undergo endovascular TAAA repair. Mean age was 72 years old. Two patients were excluded after 1-mm-slice CTA analysis. Eleven patients have underdone TAAA repair so far. The mean follow-up period at present is 8 months (range, 18 days-21 months). Overall technical success was accomplished in all 11 patients. Two renal artery branches occluded. Operative times varied from 3 to 8 hours. Mean contrast volume was 193 mL (range, 48-420 mL). Eight patients required a stay of </=4 days at the intensive care unit. Three patients died. Two deaths were procedurally related: one patient died of myocardial infarction, and the other had ischemic cerebellar stroke and died 3 months later of pulmonary sepsis. The third patient was readmitted 3 days after hospital discharge and died of alcoholic pancreatitis. One man had permanent paraplegia. Two women had transitory paraparesis. Striking hematologic and systemic inflammatory abnormalities were observed.
Increasing reports on stent graft technology indicate that this procedure might become a reality in the future for endovascular treatment of complex aneurysms in all aortic segments. Branched stent grafts seem to be feasible and can be offered as an effective alternative to most patients with TAAAs, especially for those who are currently excluded from open surgical procedures.
本研究报告了在胸腹主动脉瘤（TAAA）高危患者中应用分支型覆膜支架的初步临床结果及规划经验。
本研究纳入了TAAA高危患者。基于计算机断层扫描血管造影（CTA）评估，为选定患者设计了21个定制的分支型覆膜支架。2例患者合并双侧髂总动脉瘤，因此也使用了髂分支装置。
2006年8月至2008年4月，选择23例患者（10例女性，13例男性）接受血管腔内TAAA修复术。平均年龄为72岁。1毫米层厚CTA分析后排除2例患者。目前已有11例患者接受了TAAA修复术。目前平均随访期为8个月（范围18天至21个月）。11例患者全部获得了总体技术成功。2支肾动脉分支闭塞。手术时间为3至8小时。平均造影剂用量为193毫升（范围48至420毫升）。8例患者在重症监护病房的住院时间≤4天。3例患者死亡。2例死亡与手术相关：1例患者死于心肌梗死，另1例发生缺血性小脑卒，3个月后死于肺部感染。第3例患者出院3天后再次入院，死于酒精性胰腺炎。1例男性发生永久性截瘫。2例女性发生暂时性轻瘫。观察到明显的血液学和全身炎症异常。
关于覆膜支架技术的报道日益增多，表明该手术未来可能成为所有主动脉节段复杂性动脉瘤血管腔内治疗的现实选择。分支型覆膜支架似乎是可行的，对于大多数TAAA患者，尤其是目前被排除在开放手术之外的患者，可以作为一种有效的替代方案。
