Klinikum Wetzlar, Medizinische Klinik 1, Forsthausstr 1, 35578 Wetzlar, Germany.
Cardiovasc Intervent Radiol. 2010 Jun;33(3):492-7. doi: 10.1007/s00270-009-9773-6. Epub 2010 Jan 5.
Endovascular treatment is an established therapy for thoracic aortic disease. Collapse of the endograft is a potentially fatal complication. We reviewed 16 patients with a thoracic endograft between 2001 and 2006. Medical records of the treated patients were studied. Data collected include age, gender, diagnosis, indication for endoluminal treatment, type of endograft, and time of follow up. All patients (n = 16; mean age, 61 years; range, 21-82 years) underwent computed tomography (CT) for location of the lesion and planning of the intervention. Time of follow-up with CT scan ranged from 1 to 61 months. Indications for endovascular treatment were degenerative aneurysm (n = 7; 44%), aortic dissection (n = 2; 12%), perforated aortic ulcer (n = 4; 25%), and traumatic aortic injury (n = 3; 19%). Three patients suffered from a collapse of the endograft (one patient distal, two patients proximal) between 3 and 8 days after endovascular treatment. These patients were younger (mean age, 37 +/- 25 years vs. 67 +/- 16 years; P < 0.05) and showed more oversizing (proximal, 36 +/- 19.8% vs. 29 +/- 20.7% [P > 0.05]; distal, 45 +/- 23.5% vs. 38 +/- 21.7% [P > 0.05]). Proximal collapse was corrected by placing a bare stent. In conclusion, risk factors for stent-graft collapse are a small lumen of the aorta and a small radius of the aortic arch curvature (young patients), as well as oversizing, which is an important risk factor and is described for different types of endografts and protheses (Gore TAG and Cook Zenith). Dilatation of the collapsed stent-graft is not sufficient. Following therapy implantation of a second stent or surgery is necessary in patients with a proximal endograft collapse. Distal endograft collapse can possibly be treated conservatively under close follow-up.
血管内治疗是治疗胸主动脉疾病的一种既定疗法。移植物塌陷是一种潜在的致命并发症。我们回顾了 2001 年至 2006 年间接受胸主动脉内移植物治疗的 16 名患者。研究了治疗患者的病历。收集的数据包括年龄、性别、诊断、腔内治疗的适应证、移植物类型和随访时间。所有患者（n = 16；平均年龄 61 岁；范围 21-82 岁）均接受计算机断层扫描（CT）检查以确定病变位置并规划干预措施。CT 扫描的随访时间为 1 至 61 个月。血管内治疗的适应证为退行性动脉瘤（n = 7；44%）、主动脉夹层（n = 2；12%）、穿透性主动脉溃疡（n = 4；25%）和创伤性主动脉损伤（n = 3；19%）。3 名患者在血管内治疗后 3 至 8 天发生移植物塌陷（1 名患者远端，2 名患者近端）。这些患者更年轻（平均年龄 37 +/- 25 岁与 67 +/- 16 岁；P < 0.05），并且过度扩张更大（近端，36 +/- 19.8%与 29 +/- 20.7%[P > 0.05]；远端，45 +/- 23.5%与 38 +/- 21.7%[P > 0.05]）。近端塌陷通过放置裸支架进行矫正。总之，支架移植物塌陷的危险因素是主动脉管腔小和主动脉弓曲率半径小（年轻患者），以及过度扩张，这是一个重要的危险因素，并且与不同类型的内移植物和假体（戈尔 TAG 和库克 Zenith）有关。塌陷支架移植物的扩张是不够的。在近端移植物塌陷的患者中，在治疗后植入第二个支架或手术是必要的。远端移植物塌陷可能可以在密切随访下保守治疗。
