Department of Vascular and Endovascular Surgery, Ruprecht-Karls University, Heidelberg, Germany.
J Vasc Surg. 2010 Feb;51(2):299-304. doi: 10.1016/j.jvs.2009.08.049.
To analyze early and midterm results after endovascular treatment of ruptured thoracic aortic aneurysms (rTAA).
Between January 1997 and January 2009, a total of 236 patients received thoracic aortic repair in our institution; 23 patients (14 men; median age, 75 years; range, 60-88 years) due to a ruptured thoracic aortic aneurysm (rTAA). Rupture was defined according to computed tomography angiography (CTA) criteria with definite sign for hemorrhage outside the aortic wall. Patients with symptomatic TAA but with normal CT scans were excluded. A retrospective analysis of these patients was performed. Median follow up was 28 months (range, 0.1-82.5 months) and included serial aortic imaging at discharge, six, and 12 months and annually thereafter.
Technical success rate was 87%. The overall in hospital mortality was 48% with predominantly (50%) cardiac complications. Neurological complications occurred in three patients, two patients suffered from a transient ischemic attack (TIA)/stroke, and one patient experienced paraplegia after early conversion to open surgery. Primary endoleaks were seen in four of 25 patients (16%); no secondary endoleak was observed. Early conversion was necessary in two patients caused by an aortoesophageal fistula. The one- and three-year survival rates were 37.3% and 29.9% with no aortic or procedure-related death during follow up. Reintervention was necessary in four of 25 patients (16%). Cox regression analysis revealed preoperative renal insufficiency (hazard ratio [HR] 5.85, P = .0073) as an independent predictor of perioperative death.
The endovascular treatment of ruptured thoracic aortic aneurysms is associated with a high perioperative mortality and morbidity as well as poor midterm survival. Renal insufficiency proved to be an independent risk factor for perioperative death.
分析腔内治疗破裂性胸主动脉瘤（rTAA）的早期和中期结果。
1997 年 1 月至 2009 年 1 月期间，共有 236 例患者在我院接受了胸主动脉修复；23 例患者（14 例男性；中位年龄 75 岁；范围，60-88 岁）由于破裂性胸主动脉瘤（rTAA）。根据计算机断层血管造影（CTA）标准，明确主动脉壁外有出血迹象，定义为破裂。排除有症状性 TAA 但 CTA 正常的患者。对这些患者进行了回顾性分析。中位随访时间为 28 个月（范围，0.1-82.5 个月），包括出院时、术后 6 个月和 12 个月以及此后每年的主动脉成像。
技术成功率为 87%。总的住院死亡率为 48%，主要是（50%）心脏并发症。3 例发生神经系统并发症，2 例发生短暂性脑缺血发作（TIA）/中风，1 例术后早期转为开放手术后发生截瘫。25 例患者中有 4 例（16%）出现原发性内漏；未观察到继发性内漏。由于发生食管-主动脉瘘，有 2 例需要早期转为开放手术。1 年和 3 年的生存率分别为 37.3%和 29.9%，随访期间无主动脉或手术相关死亡。25 例患者中有 4 例（16%）需要再次干预。Cox 回归分析显示，术前肾功能不全（危险比[HR]5.85，P =.0073）是围手术期死亡的独立预测因素。
腔内治疗破裂性胸主动脉瘤的围手术期死亡率和发病率较高，中期生存率较差。肾功能不全被证明是围手术期死亡的独立危险因素。
