Kirkwood Melissa L, Pochettino Alberto, Fairman Ronald M, Jackson Benjamin M, Woo Edward Y, Wang Grace J
Department of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Vasc Endovascular Surg. 2010 Aug;44(6):440-5. doi: 10.1177/1538574410371525. Epub 2010 Jun 2.
We report our experience following thoracic aortic endovascular repair (TEVAR) explant.
A total of 500 TEVARs were performed from 1999 to 2009, with 4 requiring explant. Chart review was performed to identify the indications of explant, operative technique, and perioperative morbidity and mortality.
Indications of graft removal included device maldeployment, type I endoleak, aortoenteric fistula, and retrograde type A dissection necessitating aortic root replacement. Reconstruction was achieved with aortic homograft, Dacron, or explant of the proximal component with incorporation of the distal stent into the suture line. Mean follow-up was 13 months (0-50 months). Paraplegia and perioperative death occurred in 1 patient who underwent intraoperative conversion to open repair. There were no other major complications, and graft removal was achieved in all patients.
Although rare, familiarity with TEVAR explant is imperative as it is increasingly performed for broader indications. Our limited data suggest that explant can be performed successfully albeit with morbidity.
我们报告胸主动脉腔内修复术（TEVAR）取出术后的经验。
1999年至2009年共进行了500例TEVAR手术，其中4例需要取出。通过查阅病历确定取出的指征、手术技术以及围手术期的发病率和死亡率。
移植物取出的指征包括装置部署不当、I型内漏、主动脉肠瘘以及需要进行主动脉根部置换的逆行A型夹层。采用主动脉同种异体移植物、涤纶补片进行重建，或将近端组件取出并将远端支架纳入缝合线。平均随访时间为13个月（0至50个月）。1例术中转为开放修复的患者发生了截瘫和围手术期死亡。无其他严重并发症，所有患者均成功取出移植物。
尽管TEVAR取出术很少见，但随着其应用指征越来越广泛，熟悉该手术至关重要。我们有限的数据表明，尽管存在一定发病率，但取出术仍可成功进行。
