Albors Jose, Bahamonde Jose Angel, Juez Marina, Alcocer Jorge, Boix Ricardo, Rueda Cristina, Martín Iván, Tébar Eduardo, Palmero Julio
Service of Cardiovascular Surgery, Hospital Clínico Universitario, Valencia, Spain.
J Card Surg. 2009 Sep-Oct;24(5):534-8. doi: 10.1111/j.1540-8191.2009.00920.x.
Endovascular repair of the thoracic aorta has shown reduced morbidity and mortality compared with open surgery. We describe our experience with endovascular stent grafting in the treatment of acute thoracic aortic pathology.
From October 2003 to January 2008, 25 patients underwent endovascular stent graft repair of the thoracic aorta. The underlying pathology was a complicated Stanford type B dissection (n = 13), a symptomatic or ruptured thoracic aorta aneurysm (n = 6), a symptomatic penetrating atherosclerotic ulcer (n = 5), or a traumatic aortic injury (n = 1). There were 21 males and four female patients with a mean age of 61.3 years (30-91 years). Routine surveillance included clinical evaluation and contrast-enhanced spiral computed tomography scans before discharge and at 3, 6, and 12 months after the procedure and yearly thereafter.
Stent graft placement was technically successful in all patients. There was no intraoperative mortality. Hospital mortality was of two patients (8%). Paraparesis occurred in one patient (4%). Average intensive care unit and hospital stay was 1 and 10 days, respectively. The mean follow-up was 30 months (range, 7-53). Late mortality was in one patient (4%), due to a type A dissection. During the follow-up, four patients (16%) required a second procedure for type I endoleak.
Mortality and morbidity in our small series were low. Close follow-up is mandatory and long-term results have to be awaited.
与开放手术相比，胸主动脉腔内修复术已显示出更低的发病率和死亡率。我们描述了我们在腔内支架植入治疗急性胸主动脉病变方面的经验。
2003年10月至2008年1月，25例患者接受了胸主动脉腔内支架修复术。潜在病理情况为复杂的B型主动脉夹层（n = 13）、有症状或破裂的胸主动脉瘤（n = 6）、有症状的穿透性动脉粥样硬化溃疡（n = 5）或创伤性主动脉损伤（n = 1）。有21例男性和4例女性患者，平均年龄61.3岁（30 - 91岁）。常规监测包括出院前、术后3、6和12个月以及此后每年的临床评估和对比增强螺旋计算机断层扫描。
所有患者的支架植入技术均成功。无术中死亡。2例患者发生医院死亡（8%）。1例患者发生截瘫（4%）。重症监护病房和住院的平均时间分别为1天和10天。平均随访30个月（范围7 - 53个月）。1例患者（4%）发生晚期死亡，原因是A型夹层。随访期间，4例患者（16%）因I型内漏需要二次手术。
我们这一小系列病例的死亡率和发病率较低。必须进行密切随访，且需等待长期结果。
