Wagner Roland H, Krenzien Jörg, Gussmann Andreas
Department of Vascular and Thoracic Surgery, Klinikum Ernst von Bergmann, Academic Teaching Hospital Humboldt University Berlin, Potsdam, Germany.
Ger Med Sci. 2006 Apr 12;4:Doc03.
21 patients (17 men, 4 women; mean age 66.1 years, range 29-90 years) with 15 true aneurysms, and 6 type B-dissections were treated by implantation of a Talent Endoluminal Stentgraft System from February 2000 to July 2003. In 3 cases it was necessary to overstent the left subclavian artery, in 1 case to overstent the left common carotid.
2 patients (9.5%) died during the first 30 days (1 myocardial infarction, 1 pneumonia). Two patients (9.5%) suffered from cerebral ischemia and needed revascularisation. No paraplegia, no stroke occurred. One endoleak required additional stenting. No patient needed conversion. Follow-up, average 25.4 months (range 0-39), was 100% complete. During this another two patients died of myocardial infarction i.e. 9.5% (the above mentioned endoleak, but no late migration were detected in the remaining patients). In all cases the graft lumen stayed patent.
Treatment of descending thoracic aortic aneurysm with an endovascular approach has acceptable mortality and morbidity-rates even in high risk patients. Procedural overstenting of the subclavian artery requires subclavian revascularisation in a minority of cases.
2000年2月至2003年7月，采用Talent腔内支架移植物系统对21例患者（17例男性，4例女性；平均年龄66.1岁，范围29 - 90岁）进行治疗，其中15例为真性动脉瘤，6例为B型夹层动脉瘤。3例患者需要对左锁骨下动脉进行覆膜支架置入，1例需要对左颈总动脉进行覆膜支架置入。
2例患者（9.5%）在术后30天内死亡（1例死于心肌梗死，1例死于肺炎）。2例患者（9.5%）发生脑缺血，需要进行血管重建。未发生截瘫和中风。1例内漏需要额外置入支架。无患者需要转为开放手术。随访平均25.4个月（范围0 - 39个月），随访率达100%。在此期间，又有2例患者死于心肌梗死，即9.5%（上述内漏情况，但其余患者未发现晚期移位）。所有病例中移植物管腔均保持通畅。
即使对于高危患者，采用血管腔内方法治疗降主动脉瘤的死亡率和发病率也可接受。少数情况下，对锁骨下动脉进行术中覆膜支架置入需要进行锁骨下动脉血管重建。
