Caddell Kirk A, Song Howard K, Landry Gregory J, Kolbeck Kenneth J, Slater Matthew S, Liem Timothy K, Guyton Steven, Moneta Gregory, Kaufman John A
Division of Cardiothoracic Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
Heart Surg Forum. 2009 Aug;12(4):E187-93. doi: 10.1532/HSF98.20091031.
Endografts originally designed and approved for the treatment of thoracic aortic aneurysms have rapidly been adopted for nonapproved use in the treatment of disorders of the thoracic aorta, including aortic transection, dissection, pseudoaneurysms, and thoracoabdominal aneurysms. The purpose of this study was to evaluate the early outcomes of patients treated with thoracic endografts for nonapproved indications at our institution.
The medical records of patients undergoing thoracic endografting at our institution from August 2005 until March 2008 were reviewed. Patients undergoing endografting for uncomplicated thoracic aortic aneurysms were excluded. The outcomes of patients with extended indications for thoracic endografting were studied.
During the study period, endografting was performed in 31 patients for nonapproved aortic conditions. Patients underwent endografting for a spectrum of indications, including aortic transection (n = 12), complications of type B aortic dissection including rupture (n = 9), thoracoabdominal aneurysm with visceral debranching (n = 6), aortic arch debranching (n = 2), and pseudoaneurysm associated with prior coarctation repair (n = 2). Early outcomes were favorable. All patients had successful endograft repair of their anatomic lesion. There were no endoleaks. There was no hospital mortality. Average hospitalization was 15 days for patients with aortic transection and 9 days for all other patients.
Thoracic endografts are versatile devices that with appropriate expertise can be used effectively to treat a spectrum of disorders of the thoracic aorta, including acute emergencies. Early outcomes of patients with extended indications for thoracic endografting compare favorably to published series of patients treated with open procedures. Further study is required to assess the long-term efficacy of these devices.
最初设计并获批用于治疗胸主动脉瘤的腔内移植物已迅速被用于未经批准的治疗胸主动脉疾病，包括主动脉横断、夹层、假性动脉瘤和胸腹主动脉瘤。本研究的目的是评估在我们机构接受胸主动脉腔内移植物治疗未经批准适应症患者的早期结局。
回顾了2005年8月至2008年3月在我们机构接受胸主动脉腔内移植物植入术患者的病历。排除接受腔内移植物植入术治疗单纯性胸主动脉瘤的患者。研究了胸主动脉腔内移植物植入术适应症扩展患者的结局。
在研究期间，31例患者因未经批准的主动脉疾病接受了腔内移植物植入术。患者接受腔内移植物植入术的适应症范围广泛，包括主动脉横断（n = 12）、B型主动脉夹层并发症包括破裂（n = 9）、带内脏去分支的胸腹主动脉瘤（n = 6）、主动脉弓去分支（n = 2）以及与既往缩窄修复相关的假性动脉瘤（n = 2）。早期结局良好。所有患者的解剖病变均成功进行了腔内移植物修复。无内漏。无住院死亡。主动脉横断患者的平均住院时间为15天，其他所有患者为9天。
胸主动脉腔内移植物是多功能装置，具备适当专业知识时可有效用于治疗一系列胸主动脉疾病，包括急性紧急情况。胸主动脉腔内移植物植入术适应症扩展患者的早期结局与已发表的接受开放手术治疗患者系列相比具有优势。需要进一步研究来评估这些装置的长期疗效。
